|
| |
|
8000 Highway 23 Belle Chasse LA 70037-2442 | |
| (504) 391-0000 | |
| (504) 391-3737 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 8000 Highway 23, Belle Chasse, Louisiana |
| Authorized Official Name and Position | Ivonne I Castro (OWNER) |
| Authorized Official Contact | 5043910000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
8000 Highway 23 Belle Chasse LA 70037-2442 Ph: (504) 391-0000 | 8000 Highway 23 Belle Chasse LA 70037-2442 Ph: (504) 391-0000 |
| NPI Number | 1417278391 |
|---|---|
| Provider Enumeration Date | 06/15/2010 |
| Last Update Date | 06/15/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417278391 | NPI | - | NPPES |
| 1856258 | Medicaid | LA | |
| 1854379 | Medicaid | LA | |
| 1856991 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 5437 (Louisiana) | Primary |
| 122300000X | Dentist | 5625 (Louisiana) | Secondary |
| 1223E0200X | Dentist - Endodontics | 5699 (Louisiana) | Secondary |
Belle Chasse Family Dentistry, Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 8951 Highway 23, Belle Chasse, LA 70037 Phone: 504-394-6200 |