Provider Demographics
NPI:1710125216
Name:ABITA DENTAL CARE LLC
Entity Type:Organization
Organization Name:ABITA DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:PFINGSTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:985-892-3250
Mailing Address - Street 1:PO BOX 515
Mailing Address - Street 2:
Mailing Address - City:ABITA SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70420-0515
Mailing Address - Country:US
Mailing Address - Phone:985-892-3250
Mailing Address - Fax:985-892-3153
Practice Address - Street 1:71623 HICKORY ST
Practice Address - Street 2:
Practice Address - City:ABITA SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70420-3850
Practice Address - Country:US
Practice Address - Phone:985-892-3250
Practice Address - Fax:985-892-3153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5768122300000X
LA5054122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty