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General NPI Number Information
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NPI Number | 1528241064
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Entity Type | Organization
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Legal Business Name | KIDS DENTAL ZONE LLC
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Dates
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Enumeration Date | 12/06/2007
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Last Update Date | 12/06/2007
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Provider Practice Location Address
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Address Line | 4001 LAPALCO BLVD SUITE 16 17 18 19
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City | HARVEY
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State | LA
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Zip | 70058
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Country | US
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Telephone | 504-340-2004
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Fax |
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Provider Business Mailing Address
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Address Line | 2960 E GAUSE BLVD
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City | SLIDELL
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State | LA
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Zip | 70461
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Country | US
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Telephone | 985-641-3988
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Fax | 985-646-2536
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Authorized Official
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Title or Position | OWNER
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Name | EDWARD L DONALDSON JR.
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Credential | DDS
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Telephone | 985-641-3988
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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