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General NPI Number Information
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NPI Number | 1154543288
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Entity Type | Organization
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Legal Business Name | LSU HEALTH SCIENCES CENTER LSU FACULTY DENTAL PRACTICE
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 07/23/2014
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Provider Practice Location Address
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Address Line | 1100 FLORIDA AVE BOX 131
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City | NEW ORLEANS
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State | LA
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Zip | 70119-2714
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Country | US
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Telephone | 504-619-8721
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Fax | 504-941-8001
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Provider Business Mailing Address
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Address Line | 1100 FLORIDA AVE BOX 131
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City | NEW ORLEANS
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State | LA
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Zip | 70119-2714
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Country | US
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Telephone | 504-619-8721
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Fax | 504-941-8001
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. SUE H. SPEEGLE
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Credential | CPA
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Telephone | 504-941-8119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number | 5003
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License Number State | LA
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