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General NPI Number Information
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NPI Number | 1740534064
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Entity Type | Organization
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Legal Business Name | LOUISIANA STATE UNIVERSITY SCHOOL OF MEDICINE IN NEW ORLEANS FACULTY G
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Dates
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Enumeration Date | 11/08/2012
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 478 S JOHNSON ST FL 6
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City | NEW ORLEANS
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State | LA
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Zip | 70112-2238
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Country | US
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Telephone | 504-412-1819
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Fax |
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Provider Business Mailing Address
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Address Line | 478 S JOHNSON ST FL 6
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City | NEW ORLEANS
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State | LA
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Zip | 70112-2238
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | ATARA MCAVOY
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Credential |
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Telephone | 504-412-1819
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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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