Provider Demographics
NPI:1417124421
Name:THERESE DINH DDS LLC
Entity Type:Organization
Organization Name:THERESE DINH DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESE
Authorized Official - Middle Name:
Authorized Official - Last Name:DINH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:225-275-3837
Mailing Address - Street 1:1119 TAMARI DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-7605
Mailing Address - Country:US
Mailing Address - Phone:225-275-3837
Mailing Address - Fax:225-275-3893
Practice Address - Street 1:1119 TAMARI DRIVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-7605
Practice Address - Country:US
Practice Address - Phone:225-275-3837
Practice Address - Fax:225-275-3893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA45441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1881775Medicaid