Provider Demographics
NPI:1689168361
Name:THERIOT FAMILY DENTAL CARE- BATON ROUGE
Entity Type:Organization
Organization Name:THERIOT FAMILY DENTAL CARE- BATON ROUGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:THERIOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-258-4939
Mailing Address - Street 1:14608 S HARRELLS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-2926
Mailing Address - Country:US
Mailing Address - Phone:225-751-9966
Mailing Address - Fax:
Practice Address - Street 1:14608 S HARRELLS FERRY RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2926
Practice Address - Country:US
Practice Address - Phone:225-751-9966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental