Provider Demographics
NPI:1205676350
Name:MODEL DENTISTRY GREENWELL SPRINGS LLC
Entity type:Organization
Organization Name:MODEL DENTISTRY GREENWELL SPRINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:RABORN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:225-261-0043
Mailing Address - Street 1:14127 GREENWELL SPRINGS RD STE A
Mailing Address - Street 2:
Mailing Address - City:GREENWELL SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70739-3305
Mailing Address - Country:US
Mailing Address - Phone:225-261-0043
Mailing Address - Fax:225-261-0046
Practice Address - Street 1:14127 GREENWELL SPRINGS RD STE A
Practice Address - Street 2:
Practice Address - City:GREENWELL SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70739-3305
Practice Address - Country:US
Practice Address - Phone:225-261-0043
Practice Address - Fax:225-261-0046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty