Provider Demographics
NPI:1942922026
Name:ZACHARY DENTAL PROFESSIONALS, LLC
Entity Type:Organization
Organization Name:ZACHARY DENTAL PROFESSIONALS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MONTRELLE
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:225-570-8030
Mailing Address - Street 1:19900 OLD SCENIC HWY STE E
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-7368
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19900 OLD SCENIC HWY STE E
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-7368
Practice Address - Country:US
Practice Address - Phone:225-719-3530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental