Healthcare Provider Details

I. General information

NPI: 1912724253
Provider Name (Legal Business Name): LIT SMILES OF BATON ROUGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8482 PERKINS RD STE B
BATON ROUGE LA
70810-1022
US

IV. Provider business mailing address

20755 CHARLES ORY DR
PLAQUEMINE LA
70764-5318
US

V. Phone/Fax

Practice location:
  • Phone: 225-383-3000
  • Fax:
Mailing address:
  • Phone: 225-247-1484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER BUTLER
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 225-247-1484