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NPI Code Detail

MEDICARE: PERIODONTICS AND IMPLANT CENTER LLC

MEDICARE: PERIODONTICS AND IMPLANT CENTER LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223P0300XPeriodontics5315LA

General Provider Information

NPI Number : 1023350543
Entity Type Code : Organization
Provider Name (Legal Business Name) : PERIODONTICS AND IMPLANT CENTER LLC
Provider Business Mailing Address
First Line : 4451 BLUEBONNET BLVD
Second Line : SUITE F
City : BATON ROUGE
State : LA
Zip : 70809-9646
Country : US
Telephone Number : 225-767-2273
Fax Number :
Provider Business Practice Location Address
First Line : 8202 KELWOOD AVE
Second Line :
City : BATON ROUGE
State : LA
Zip : 70806-4801
Country : US
Telephone Number : 225-767-2273
Fax Number :
Authorized Official
Title or Position : OWNER
Name : ANDRE BRUNI
Credential : DDS
Telephone Number : 225-767-2273
Provider Enumeration Date : 03/22/2013
Last Update Date : 03/22/2013

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Directions to “PERIODONTICS AND IMPLANT CENTER LLC ” Practice Location

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