Provider Demographics
NPI:1366829673
Name:LACOUR DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:LACOUR DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:LACOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:225-757-8450
Mailing Address - Street 1:719 E AIRPORT AVE
Mailing Address - Street 2:#A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-6558
Mailing Address - Country:US
Mailing Address - Phone:225-924-3369
Mailing Address - Fax:225-924-3387
Practice Address - Street 1:719 E AIRPORT AVE
Practice Address - Street 2:#A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6558
Practice Address - Country:US
Practice Address - Phone:225-924-3369
Practice Address - Fax:225-924-3387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5037122300000X
LA2798122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA29635Medicaid