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General NPI Number Information
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NPI Number | 1700544871
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Entity Type | Organization
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Legal Business Name | EXCEPTIONAL DENTAL OF LONG BEACH, LLC
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Dates
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Enumeration Date | 12/06/2021
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Last Update Date | 12/13/2021
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Provider Practice Location Address
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Address Line | 5107 BEATLINE RD STE 800
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City | LONG BEACH
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State | MS
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Zip | 39560-3879
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Country | US
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Telephone | 228-250-0350
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Fax |
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Provider Business Mailing Address
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Address Line | 1 GALLERIA BLVD STE 1518
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City | METAIRIE
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State | LA
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Zip | 70001-2082
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Country | US
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Telephone | 504-609-2599
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Fax | 504-386-4956
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Authorized Official
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Title or Position | INSURANCE CREDENTIALING MANAGER
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Name | MRS. SAMANTHA COATS
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Credential |
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Telephone | 504-609-2599
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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 |
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License Number State |
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