Healthcare Provider Details

I. General information

NPI: 1528583945
Provider Name (Legal Business Name): BATON ROUGE PERIO, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10723 N. OAK HILLS PARKWAY, BLDG. B
BATON ROUGE LA
70810
US

IV. Provider business mailing address

10723 N. OAK HILLS PARKWAY, BLDG. B
BATON ROUGE LA
70810
US

V. Phone/Fax

Practice location:
  • Phone: 225-769-1444
  • Fax: 225-769-9939
Mailing address:
  • Phone: 225-769-1444
  • Fax: 225-769-9939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. KENNETH FORD MARKLE
Title or Position: DENTIST
Credential: D.D.S.
Phone: 225-769-1444