Provider Demographics
NPI:1205006780
Name:OUTREACH DENTISTRY
Entity Type:Organization
Organization Name:OUTREACH DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FOLSE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:337-993-0977
Mailing Address - Street 1:510 GUILBEAU RD STE C
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-8415
Mailing Address - Country:US
Mailing Address - Phone:337-993-0977
Mailing Address - Fax:337-993-0978
Practice Address - Street 1:510 GUILBEAU RD STE C
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-8415
Practice Address - Country:US
Practice Address - Phone:337-993-0977
Practice Address - Fax:337-993-0978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty