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General NPI Number Information
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NPI Number | 1104376714
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Entity Type | Organization
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Legal Business Name | EASYCAREWELLNESSANDDENTISTRY LLC
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Dates
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Enumeration Date | 10/06/2016
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Last Update Date | 10/06/2016
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Provider Practice Location Address
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Address Line | 2145 REV. RICHARD WILSON DR
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City | KENNER
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State | LA
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Zip | 70062
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Country | US
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Telephone | 504-258-8870
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Fax |
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Provider Business Mailing Address
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Address Line | 5138 MARIGNY ST
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City | NEW ORLEANS
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State | LA
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Zip | 70122-5118
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Country | US
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Telephone | 504-258-8870
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. JOHNNY MCLAUGHLIN III
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Credential |
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Telephone | 504-258-8870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 122300000X
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License Number State |
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Taxonomy #2
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Taxonomy Code | 156FX1100X
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Taxonomy Name | Ophthalmic Technician/Technologist
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License Number | 156FX1100X
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 207R00000X
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 207W00000X
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License Number State |
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