Healthcare Provider Details

I. General information

NPI: 1679062574
Provider Name (Legal Business Name): SCOTT V. LAW, D.M.D. LOUISIANA, A PROFESSIONAL DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2018
Last Update Date: 05/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 MANHATTAN BLVD STE D
HARVEY LA
70058-2904
US

IV. Provider business mailing address

5732 SALMEN ST STE C
ELMWOOD LA
70123-2288
US

V. Phone/Fax

Practice location:
  • Phone: 504-368-7513
  • Fax:
Mailing address:
  • Phone: 800-864-1582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number6638
License Number StateLA

VIII. Authorized Official

Name: SCOTT V LAW
Title or Position: OWNER
Credential: DMD
Phone: 800-864-1582