Healthcare Provider Details

I. General information

NPI: 1508867334
Provider Name (Legal Business Name): BATON ROUGE DENTAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

679 E AIRPORT AVE
BATON ROUGE LA
70806-6517
US

IV. Provider business mailing address

679 E AIRPORT AVE
BATON ROUGE LA
70806-6517
US

V. Phone/Fax

Practice location:
  • Phone: 225-926-2195
  • Fax: 225-926-2192
Mailing address:
  • Phone: 225-926-2195
  • Fax: 225-926-2192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4666
License Number StateLA

VIII. Authorized Official

Name: DR. JULIE A VIGNES
Title or Position: DENTIST
Credential: DDS
Phone: 225-926-2195