Provider Demographics
NPI:1851458467
Name:DRS CHISHOLM HARRISON SANDIFER
Entity Type:Organization
Organization Name:DRS CHISHOLM HARRISON SANDIFER
Other - Org Name:GEORGE HARRISON WILLIAM CHISHOLM ALAN SANDIFER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:W
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:IV
Authorized Official - Credentials:DMD
Authorized Official - Phone:225-923-2160
Mailing Address - Street 1:6721 GOVERNMENT ST
Mailing Address - Street 2:STE D
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806
Mailing Address - Country:US
Mailing Address - Phone:225-923-2160
Mailing Address - Fax:225-923-3009
Practice Address - Street 1:6721 GOVERNMENT ST
Practice Address - Street 2:STE D
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806
Practice Address - Country:US
Practice Address - Phone:225-923-2160
Practice Address - Fax:225-923-3009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA45841223E0200X
LA31581223E0200X
LA31281223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty