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General NPI Number Information
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NPI Number | 1164892014
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Entity Type | Organization
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Legal Business Name | BBO, LLC
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Dates
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Enumeration Date | 10/05/2015
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Last Update Date | 10/05/2015
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Provider Practice Location Address
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Address Line | 1929 JUTLAND DR
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City | HARVEY
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State | LA
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Zip | 70058-2360
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Country | US
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Telephone | 504-455-1625
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Fax | 504-455-7604
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Provider Business Mailing Address
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Address Line | 4429 CHASTANT ST
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City | METAIRIE
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State | LA
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Zip | 70006-2053
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Country | US
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Telephone | 504-455-1625
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Fax | 504-455-7604
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Authorized Official
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Title or Position | OWNER
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Name | ERIC MACALUSO
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Credential | DDS
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Telephone | 504-455-1625
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 5577
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License Number State | LA
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