Provider Demographics
NPI:1265910210
Name:LACOMBE DENTAL LLC
Entity type:Organization
Organization Name:LACOMBE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:WEBSTER
Authorized Official - Last Name:QUARTANO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:985-327-6501
Mailing Address - Street 1:6061 PINNACLE PKWY
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433
Mailing Address - Country:US
Mailing Address - Phone:985-327-6501
Mailing Address - Fax:985-327-6506
Practice Address - Street 1:27403 HWY 190 SU A
Practice Address - Street 2:
Practice Address - City:LACOMBE
Practice Address - State:LA
Practice Address - Zip Code:70445
Practice Address - Country:US
Practice Address - Phone:985-218-9445
Practice Address - Fax:985-218-9447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty