Provider Demographics
NPI:1417428798
Name:BATON ROUGE FAMILY DENTISTRY
Entity Type:Organization
Organization Name:BATON ROUGE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:CARMOUCHE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:225-445-2690
Mailing Address - Street 1:21 TURNBERRY DR
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-1617
Mailing Address - Country:US
Mailing Address - Phone:225-445-2690
Mailing Address - Fax:
Practice Address - Street 1:12117 COURSEY BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-4410
Practice Address - Country:US
Practice Address - Phone:225-456-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental