Healthcare Provider Details

I. General information

NPI: 1407972268
Provider Name (Legal Business Name): FRUGE ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12061 BRICKSOME AVE
BATON ROUGE LA
70816-2339
US

IV. Provider business mailing address

12061 BRICKSOME AVE
BATON ROUGE LA
70816-2339
US

V. Phone/Fax

Practice location:
  • Phone: 225-292-6991
  • Fax: 225-292-7210
Mailing address:
  • Phone: 225-292-6991
  • Fax: 225-292-7210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number3141
License Number StateLA

VIII. Authorized Official

Name: DENISE BLANCHARD MITCHELL
Title or Position: ACCOUNTS MANAGER
Credential:
Phone: 225-292-6991