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General NPI Number Information
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NPI Number | 1356588354
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Entity Type | Organization
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Legal Business Name | ALBANY DENTAL CLINIC
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Dates
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Enumeration Date | 01/13/2009
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Last Update Date | 01/13/2009
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Provider Practice Location Address
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Address Line | 490 SITMAN STREET
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City | GREENSBURG
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State | LA
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Zip | 70441
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Country | US
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Telephone | 225-222-6059
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Fax | 225-222-6543
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Provider Business Mailing Address
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Address Line | 29565 MONTEPELIER STREET ALBANY DENTAL CLINIC
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City | ALBANY
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State | LA
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Zip | 70711
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Country | US
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Telephone | 225-209-0850
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Fax | 225-209-0849
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Authorized Official
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Title or Position | INSURANCE CLERK
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Name | ROSE E HITCHEN
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Credential |
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Telephone | 225-209-0850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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