Healthcare Provider Details

I. General information

NPI: 1982516852
Provider Name (Legal Business Name): CUSPING EDGE DENTAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 MAPLEWOOD DR
SULPHUR LA
70663-6114
US

IV. Provider business mailing address

2920 MAPLEWOOD DR
SULPHUR LA
70663-6114
US

V. Phone/Fax

Practice location:
  • Phone: 337-625-2671
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: TAMMY LY
Title or Position: OWNER
Credential: DDS
Phone: 337-802-0988