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General NPI Number Information
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NPI Number | 1265706295
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Entity Type | Organization
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Legal Business Name | BAYOU DENTAL HEALTH
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Dates
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Enumeration Date | 03/08/2012
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Last Update Date | 11/13/2018
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Provider Practice Location Address
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Address Line | 6005 AIRLINE DR
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City | METAIRIE
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State | LA
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Zip | 70003-4330
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Country | US
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Telephone | 888-242-1608
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 23623
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City | NEW ORLEANS
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State | LA
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Zip | 70183-0623
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Country | US
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Telephone | 888-242-1608
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Fax |
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Authorized Official
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Title or Position | DENTAL DIRECTOR
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Name | DR. MAHRUFA ISLAM
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Credential | DDS
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Telephone | 888-242-1608
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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