Provider Demographics
NPI:1114451952
Name:BRITTANY G HOUSE A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:BRITTANY G HOUSE A PROFESSIONAL CORPORATION
Other - Org Name:GEAUX DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-949-8344
Mailing Address - Street 1:2114 HIGHWAY 80
Mailing Address - Street 2:
Mailing Address - City:HAUGHTON
Mailing Address - State:LA
Mailing Address - Zip Code:71037-9497
Mailing Address - Country:US
Mailing Address - Phone:318-949-8344
Mailing Address - Fax:318-617-5053
Practice Address - Street 1:2114 HIGHWAY 80
Practice Address - Street 2:
Practice Address - City:HAUGHTON
Practice Address - State:LA
Practice Address - Zip Code:71037-9497
Practice Address - Country:US
Practice Address - Phone:318-949-8344
Practice Address - Fax:318-617-5053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6499122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1864994Medicaid
LA1866466Medicaid