Provider Demographics
NPI:1417278391
Name:BELLE CHASSE DENTAL CENTER LLC
Entity Type:Organization
Organization Name:BELLE CHASSE DENTAL CENTER LLC
Other - Org Name:IVONNE I. CASTRO D.D.S
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IVONNE
Authorized Official - Middle Name:I
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:504-391-0000
Mailing Address - Street 1:8000 HIGHWAY 23
Mailing Address - Street 2:
Mailing Address - City:BELLE CHASSE
Mailing Address - State:LA
Mailing Address - Zip Code:70037-2442
Mailing Address - Country:US
Mailing Address - Phone:504-391-0000
Mailing Address - Fax:504-391-3737
Practice Address - Street 1:8000 HIGHWAY 23
Practice Address - Street 2:
Practice Address - City:BELLE CHASSE
Practice Address - State:LA
Practice Address - Zip Code:70037-2442
Practice Address - Country:US
Practice Address - Phone:504-391-0000
Practice Address - Fax:504-391-3737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5437122300000X
LA5625122300000X
LA56991223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1856258Medicaid
LA1854379Medicaid
LA1856991Medicaid