| Louisiana Dental Spa | |
|
16645 Highland Rd Ste J Baton Rouge LA 70810-6567 | |
| (225) 214-0100 | |
| (225) 214-0103 |
| Full Name | Louisiana Dental Spa |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 16645 Highland Rd Ste J, Baton Rouge, Louisiana |
| Authorized Official Name and Position | Darrell Paul Bourg (DENTIST) |
| Authorized Official Contact | 5042326624 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Louisiana Dental Spa 16645 Highland Rd Ste J Baton Rouge LA 70810-6567 Ph: (225) 214-0100 | Louisiana Dental Spa 16645 Highland Rd Ste J Baton Rouge LA 70810-6567 Ph: (225) 214-0100 |
| NPI Number | 1003970682 |
|---|---|
| Provider Enumeration Date | 12/20/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003970682 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 5312 (Louisiana) | Primary |
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