Provider Demographics
NPI:1235801044
Name:SLIDELL FAMILY DENTAL CARE, LLC
Entity Type:Organization
Organization Name:SLIDELL FAMILY DENTAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-643-4553
Mailing Address - Street 1:240 ERLANGER AVE
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-3426
Mailing Address - Country:US
Mailing Address - Phone:985-643-4553
Mailing Address - Fax:985-645-0746
Practice Address - Street 1:240 ERLANGER AVE
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-3426
Practice Address - Country:US
Practice Address - Phone:985-643-4553
Practice Address - Fax:985-645-0746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty