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General NPI Number Information
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NPI Number | 1134531486
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Entity Type | Organization
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Legal Business Name | USTDDS, INC.
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Dates
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Enumeration Date | 05/21/2014
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Last Update Date | 05/21/2014
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Provider Practice Location Address
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Address Line | 3939 HOUMA BLVD BUILDING 3 SUITE 11
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City | METAIRIE
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State | LA
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Zip | 70006-2931
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Country | US
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Telephone | 504-887-3311
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Fax |
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Provider Business Mailing Address
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Address Line | 1029 NURSERY AVE
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City | METAIRIE
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State | LA
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Zip | 70005-2321
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Country | US
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Telephone | 504-460-3419
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. BONNIE MURO UST
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Credential | D.D.S
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Telephone | 504-460-3419
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6455
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License Number State | LA
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