Provider Demographics
NPI:1619751427
Name:LOUISIANA IMPLANTS AND DENTURES
Entity Type:Organization
Organization Name:LOUISIANA IMPLANTS AND DENTURES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:VIDRINE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:337-581-5791
Mailing Address - Street 1:10330 AIRLINE HWY STE A6
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4191
Mailing Address - Country:US
Mailing Address - Phone:225-308-8000
Mailing Address - Fax:225-308-8000
Practice Address - Street 1:10330 AIRLINE HWY STE A6
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-4191
Practice Address - Country:US
Practice Address - Phone:225-308-8000
Practice Address - Fax:225-308-8000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty