Healthcare Provider Details

I. General information

NPI: 1801192836
Provider Name (Legal Business Name): ANTHONY INDOVINA A P D C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2011
Last Update Date: 02/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5132 LAPALCO BLVD 2ND FLOOR
MARRERO LA
70072-4268
US

IV. Provider business mailing address

5132 LAPALCO BLVD 2ND FLOOR
MARRERO LA
70072-4268
US

V. Phone/Fax

Practice location:
  • Phone: 504-340-2401
  • Fax: 504-340-2423
Mailing address:
  • Phone: 504-340-2401
  • Fax: 504-340-2423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2650
License Number StateLA

VIII. Authorized Official

Name: DR. ANTHONY A. INDOVINA SR.
Title or Position: OWNER/PRESIDENT
Credential: D.D.S.
Phone: 504-340-2401