| Pediatric Dentist, Pdc | |
|
2201 Veterans Memorial Blvd Suite 306 Metairie LA 70002 | |
| (504) 831-2120 | |
| (504) 831-2310 |
| Full Name | Pediatric Dentist, Pdc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 2201 Veterans Memorial Blvd, Metairie, Louisiana |
| Authorized Official Name and Position | Jason D Parker (PRESIDENT) |
| Authorized Official Contact | 5046698679 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatric Dentist, Pdc 2201 Veterans Memorial Blvd Suite 306 Metairie LA 70002 Ph: (504) 831-2120 | Pediatric Dentist, Pdc 2201 Veterans Memorial Blvd Suite 306 Metairie LA 70002 Ph: (504) 831-2120 |
| NPI Number | 1003943135 |
|---|---|
| Provider Enumeration Date | 02/27/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003943135 | NPI | - | NPPES |
| 1851329 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 5132 (Louisiana) | Primary |
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