| NPI | 1720591043 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK ANDERSON Owner 504-485-6575 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 5228) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 6564) |
| 1223G0001X Dentist, General Practice (Licence: LA 6293) | |
| Enumeration Date | 2017-11-08 |
| Last Update Date | 2017-11-08 |