Provider Demographics
NPI:1003245226
Name:DENTAL CARE GROUP
Entity Type:Organization
Organization Name:DENTAL CARE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CATRINEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:225-673-1557
Mailing Address - Street 1:16270 AIRLINE HWY
Mailing Address - Street 2:STE. B
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-4589
Mailing Address - Country:US
Mailing Address - Phone:225-673-1557
Mailing Address - Fax:225-673-6815
Practice Address - Street 1:16270 AIRLINE HWY
Practice Address - Street 2:STE. B
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-4589
Practice Address - Country:US
Practice Address - Phone:225-673-1557
Practice Address - Fax:225-673-6815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-07
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6275261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental