Provider Demographics
NPI:1003175761
Name:OAK TREE FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:OAK TREE FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CUONG
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-701-7047
Mailing Address - Street 1:105 LAVENDER CT
Mailing Address - Street 2:
Mailing Address - City:BELLE CHASSE
Mailing Address - State:LA
Mailing Address - Zip Code:70037
Mailing Address - Country:US
Mailing Address - Phone:504-701-7047
Mailing Address - Fax:
Practice Address - Street 1:1729 LAFAYETTE ST
Practice Address - Street 2:200
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053-5775
Practice Address - Country:US
Practice Address - Phone:504-227-8577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-15
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA60341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty