Provider Demographics
NPI:1164892014
Name:BBO, LLC
Entity Type:Organization
Organization Name:BBO, LLC
Other - Org Name:BROWN FAMILY ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:MACALUSO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:504-455-1625
Mailing Address - Street 1:4429 CHASTANT ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2053
Mailing Address - Country:US
Mailing Address - Phone:504-455-1625
Mailing Address - Fax:504-455-7604
Practice Address - Street 1:1929 JUTLAND DR
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-2360
Practice Address - Country:US
Practice Address - Phone:504-455-1625
Practice Address - Fax:504-455-7604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA55771223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty