Provider Demographics
NPI:1205034493
Name:PROFESSIONAL DENTAL PARTNERS
Entity Type:Organization
Organization Name:PROFESSIONAL DENTAL PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LALA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:225-926-7782
Mailing Address - Street 1:641 E AIRPORT AVE STE A
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-6545
Mailing Address - Country:US
Mailing Address - Phone:225-926-7782
Mailing Address - Fax:
Practice Address - Street 1:641 E AIRPORT AVE STE A
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6545
Practice Address - Country:US
Practice Address - Phone:225-926-7782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3847261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental