Provider Demographics
NPI:1689149155
Name:MORGAN CITY DENTAL CARE
Entity Type:Organization
Organization Name:MORGAN CITY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANCUSO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:225-978-8603
Mailing Address - Street 1:1025 N VICTOR II BLVD STE R
Mailing Address - Street 2:
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70380-1349
Mailing Address - Country:US
Mailing Address - Phone:337-643-6400
Mailing Address - Fax:
Practice Address - Street 1:1025 N VICTOR II BLVD STE R
Practice Address - Street 2:
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1349
Practice Address - Country:US
Practice Address - Phone:337-643-6400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental