Provider Demographics
NPI:1891430906
Name:IBERIA DENTAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:IBERIA DENTAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:COMEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:337-519-2882
Mailing Address - Street 1:441 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-3773
Mailing Address - Country:US
Mailing Address - Phone:337-367-2211
Mailing Address - Fax:337-367-2213
Practice Address - Street 1:441 CHARLES ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-3773
Practice Address - Country:US
Practice Address - Phone:337-367-2211
Practice Address - Fax:337-367-2213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental