Provider Demographics
NPI:1326818790
Name:MAURICE DENTAL LLC
Entity Type:Organization
Organization Name:MAURICE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANCUSO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:337-893-2207
Mailing Address - Street 1:8407 MAURICE AVE
Mailing Address - Street 2:
Mailing Address - City:MAURICE
Mailing Address - State:LA
Mailing Address - Zip Code:70555-4459
Mailing Address - Country:US
Mailing Address - Phone:337-893-2207
Mailing Address - Fax:
Practice Address - Street 1:8407 MAURICE AVE
Practice Address - Street 2:
Practice Address - City:MAURICE
Practice Address - State:LA
Practice Address - Zip Code:70555-4459
Practice Address - Country:US
Practice Address - Phone:337-893-2207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty