Healthcare Provider Details

I. General information

NPI: 1528280641
Provider Name (Legal Business Name): LSU HEALTH SCIENCES CENTER LSU FACULTY DENTAL PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 HOUMA BLVD SUITE 305
METAIRIE LA
70006-4182
US

IV. Provider business mailing address

3800 HOUMA BLVD SUITE 305
METAIRIE LA
70006-4182
US

V. Phone/Fax

Practice location:
  • Phone: 504-889-9893
  • Fax: 504-889-9895
Mailing address:
  • Phone: 504-889-9893
  • Fax: 504-889-9895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. CHRISTINE K OSBURN
Title or Position: ASSISTANT OFFICE MANAGER
Credential:
Phone: 504-889-9893