Healthcare Provider Details

I. General information

NPI: 1265983274
Provider Name (Legal Business Name): LSUHSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2016
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 FLORIDA AVE
NEW ORLEANS LA
70119-2715
US

IV. Provider business mailing address

1100 FLORIDA AVE
NEW ORLEANS LA
70119-2715
US

V. Phone/Fax

Practice location:
  • Phone: 504-432-8006
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARIA CHATZINIKOLA
Title or Position: DDS
Credential:
Phone: 504-432-8006