Provider Demographics
NPI:1073601720
Name:ASSOCIATES IN DENTAL HEALTH LLC
Entity Type:Organization
Organization Name:ASSOCIATES IN DENTAL HEALTH LLC
Other - Org Name:B R DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:MIGUEL
Authorized Official - Last Name:SUADI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:225-753-5885
Mailing Address - Street 1:15420 S HARRELLS FERRY RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-2940
Mailing Address - Country:US
Mailing Address - Phone:225-753-5885
Mailing Address - Fax:225-753-5908
Practice Address - Street 1:15420 S HARRELLS FERRY RD
Practice Address - Street 2:SUITE C
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2940
Practice Address - Country:US
Practice Address - Phone:225-753-5885
Practice Address - Fax:225-753-5908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA48181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1848182Medicaid
856322OtherUNITED CONCORDIA