Healthcare Provider Details

I. General information

NPI: 1184435620
Provider Name (Legal Business Name): SOUTH LA DENTAL SLEEP MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 01/15/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 VALHI BLVD
HOUMA LA
70360-5976
US

IV. Provider business mailing address

600 VALHI BLVD
HOUMA LA
70360-5976
US

V. Phone/Fax

Practice location:
  • Phone: 985-872-3677
  • Fax: 985-872-3680
Mailing address:
  • Phone: 985-872-3677
  • Fax: 985-872-3680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: PEDRO CUARTAS
Title or Position: OWNER
Credential: DDS
Phone: 985-872-3677