Provider Demographics
NPI:1598836421
Name:FREDERICK L BERCIER JR DDS
Entity Type:Organization
Organization Name:FREDERICK L BERCIER JR DDS
Other - Org Name:RICK BERCIER DDS PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:L
Authorized Official - Last Name:BERCIER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:337-478-3123
Mailing Address - Street 1:715 W COLLEGE STREET
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605
Mailing Address - Country:US
Mailing Address - Phone:337-478-3123
Mailing Address - Fax:337-478-3229
Practice Address - Street 1:715 W COLLEGE STREET
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605
Practice Address - Country:US
Practice Address - Phone:337-478-3123
Practice Address - Fax:337-478-3229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3250122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA625436OtherUNITED CONCORDIA
LAG1161OtherBLUE CROSS BLUE SHIELD