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General NPI Number Information
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NPI Number | 1790337632
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Entity Type | Organization
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Legal Business Name | WEST BATON ROUGE DENTAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 07/11/2019
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Last Update Date | 07/11/2019
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Provider Practice Location Address
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Address Line | 6572 HWY 1 SOUTH
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City | ADDIS
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State | LA
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Zip | 70710
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Country | US
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Telephone | 985-893-2240
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Fax | 985-893-2629
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Provider Business Mailing Address
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Address Line | 600 N. HWY 190 SUITE 200
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City | CORINGTON
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State | LA
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Zip | 70433
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Country | US
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Telephone | 985-893-2240
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Fax | 985-893-2629
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Authorized Official
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Title or Position | OWNER
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Name | JOSEPH LACOSTE JR.
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Credential | DDS
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Telephone | 985-893-2240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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