Provider Demographics
NPI:1588015531
Name:ADVANTAGE DENTAL CARE, DR. LOUIS L MASON DDS LLC
Entity Type:Organization
Organization Name:ADVANTAGE DENTAL CARE, DR. LOUIS L MASON DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-285-1547
Mailing Address - Street 1:260 S. ALEXANDER AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ALLEN
Mailing Address - State:LA
Mailing Address - Zip Code:70767
Mailing Address - Country:US
Mailing Address - Phone:225-346-1776
Mailing Address - Fax:
Practice Address - Street 1:260 S. ALEXANDER AVE
Practice Address - Street 2:
Practice Address - City:PORT ALLEN
Practice Address - State:LA
Practice Address - Zip Code:70767
Practice Address - Country:US
Practice Address - Phone:225-346-1776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6684122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty