Provider Demographics
NPI:1346420866
Name:ASSOCIATES IN PEDIATRIC DENTISTRY,LLC
Entity Type:Organization
Organization Name:ASSOCIATES IN PEDIATRIC DENTISTRY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:DELAROSA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:225-924-6622
Mailing Address - Street 1:9000 AIRLINE HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-4183
Mailing Address - Country:US
Mailing Address - Phone:225-924-6622
Mailing Address - Fax:225-926-3384
Practice Address - Street 1:9000 AIRLINE HWY STE 100
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-4183
Practice Address - Country:US
Practice Address - Phone:225-924-6622
Practice Address - Fax:225-926-3384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1881571Medicaid