Provider Demographics
NPI:1902392772
Name:CAMELLIA DENTAL LLC
Entity Type:Organization
Organization Name:CAMELLIA DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:THIMMESCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:337-989-1268
Mailing Address - Street 1:1101 CAMELLIA BLVD.
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508
Mailing Address - Country:US
Mailing Address - Phone:337-989-1268
Mailing Address - Fax:
Practice Address - Street 1:1101 CAMELLIA BLVD.
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-7050
Practice Address - Country:US
Practice Address - Phone:337-989-1268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-05
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA60031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty