Healthcare Provider Details

I. General information

NPI: 1710125216
Provider Name (Legal Business Name): ABITA DENTAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2009
Last Update Date: 01/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71623 HICKORY ST
ABITA SPRINGS LA
70420-3850
US

IV. Provider business mailing address

PO BOX 515
ABITA SPRINGS LA
70420-0515
US

V. Phone/Fax

Practice location:
  • Phone: 985-892-3250
  • Fax: 985-892-3153
Mailing address:
  • Phone: 985-892-3250
  • Fax: 985-892-3153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number5768
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5054
License Number StateLA

VIII. Authorized Official

Name: DR. STEVEN E PFINGSTEN
Title or Position: MEMBER
Credential: D.D.S.
Phone: 985-892-3250