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General NPI Number Information
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NPI Number | 1598060642
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Entity Type | Organization
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Legal Business Name | OPELOUSAS DENTAL LLC
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Dates
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Enumeration Date | 01/21/2011
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Last Update Date | 01/21/2011
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Provider Practice Location Address
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Address Line | 506 N COURT ST
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City | OPELOUSAS
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State | LA
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Zip | 70570-5220
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Country | US
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Telephone | 337-942-3441
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Fax | 337-942-3461
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Provider Business Mailing Address
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Address Line | 506 N COURT ST
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City | OPELOUSAS
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State | LA
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Zip | 70570-5220
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Country | US
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Telephone | 337-942-3441
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Fax | 337-942-3461
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | DR. BRIDGETTE MICHELLE VIDRINE
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Credential | D.D.S.
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Telephone | 337-942-3441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6040
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5885
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License Number State | LA
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