Provider Demographics
NPI:1164197075
Name:CFDC, LLC
Entity Type:Organization
Organization Name:CFDC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:QUARTANO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:985-869-6403
Mailing Address - Street 1:4450 BLUEBONNET BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-9649
Mailing Address - Country:US
Mailing Address - Phone:985-869-6403
Mailing Address - Fax:
Practice Address - Street 1:13323 HOOPER RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70818-3526
Practice Address - Country:US
Practice Address - Phone:225-261-8050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1863912Medicaid