Provider Demographics
NPI:1609994755
Name:THAIKLA,DDS,INC
Entity Type:Organization
Organization Name:THAIKLA,DDS,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER,DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:THAI
Authorized Official - Middle Name:K
Authorized Official - Last Name:LA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:504-254-4900
Mailing Address - Street 1:14401B CHEF MENTEUR HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70129-2014
Mailing Address - Country:US
Mailing Address - Phone:504-254-4900
Mailing Address - Fax:504-254-6080
Practice Address - Street 1:14401B CHEF MENTEUR HWY
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70129-2014
Practice Address - Country:US
Practice Address - Phone:504-254-4900
Practice Address - Fax:504-254-6080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA53381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1853381Medicaid