| Ponchartrain Dental, Llc | |
|
4890 Highway 22 Ste B Mandeville LA 70471-6751 | |
| (985) 845-8244 | |
| (985) 845-8255 |
| Full Name | Ponchartrain Dental, Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 4890 Highway 22 Ste B, Mandeville, Louisiana |
| Authorized Official Name and Position | Melissa Raley (OFFICE MANAGER) |
| Authorized Official Contact | 9858458244 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ponchartrain Dental, Llc 4890 Highway 22 Ste B Mandeville LA 70471-6751 Ph: (985) 845-8244 | Ponchartrain Dental, Llc 4890 Highway 22 Ste B Mandeville LA 70471-6751 Ph: (985) 845-8244 |
| NPI Number | 1780214866 |
|---|---|
| Provider Enumeration Date | 01/17/2020 |
| Last Update Date | 01/17/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780214866 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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