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General NPI Number Information
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NPI Number | 1306460001
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Entity Type | Organization
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Legal Business Name | BFD MADISONVILLE ASSOCIATES LLC
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Dates
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Enumeration Date | 05/29/2020
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Last Update Date | 05/29/2020
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Provider Practice Location Address
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Address Line | 109 PINE CREEK DRIVE SUITE B
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City | MADISONVILLE
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State | LA
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Zip | 70447
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Country | US
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Telephone | 985-590-5175
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Fax | 985-590-5165
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Provider Business Mailing Address
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Address Line | 109 PINE CREEK DRIVE SUITE B
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City | MADISONVILLE
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State | LA
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Zip | 70447
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Country | US
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Telephone | 985-590-5175
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Fax | 985-590-5165
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | MARK TINNEY
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Credential | DDS
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Telephone | 985-590-5175
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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 |
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License Number State |
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