Provider Demographics
NPI:1174009633
Name:AFFORDABLE SMILES OF BATON ROUGE, LLC
Entity Type:Organization
Organization Name:AFFORDABLE SMILES OF BATON ROUGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE CREDENTIALING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:COATS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-609-2599
Mailing Address - Street 1:1962 ONEAL LN STE A&B
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-3250
Mailing Address - Country:US
Mailing Address - Phone:225-753-5303
Mailing Address - Fax:225-753-3921
Practice Address - Street 1:2515 ONEAL LN STE 1
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-3397
Practice Address - Country:US
Practice Address - Phone:225-753-5303
Practice Address - Fax:225-753-3921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-17
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty