Provider Demographics
NPI:1114328606
Name:DESIGNER DENTAL, LLC
Entity Type:Organization
Organization Name:DESIGNER DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MONETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:504-273-7757
Mailing Address - Street 1:10001 LAKE FOREST BLVD
Mailing Address - Street 2:SUITE 509
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70127-6200
Mailing Address - Country:US
Mailing Address - Phone:504-273-7757
Mailing Address - Fax:504-273-7758
Practice Address - Street 1:10001 LAKE FOREST BLVD
Practice Address - Street 2:SUITE 509
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-6200
Practice Address - Country:US
Practice Address - Phone:504-273-7757
Practice Address - Fax:504-273-7758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA56931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty