Provider Demographics
NPI:1295837326
Name:LSU HEALTH SCIENCES CENTER LSU FACULTY DENTAL PRACTICE
Entity type:Organization
Organization Name:LSU HEALTH SCIENCES CENTER LSU FACULTY DENTAL PRACTICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MORPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-889-9893
Mailing Address - Street 1:3800 HOUMA BLVD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006
Mailing Address - Country:US
Mailing Address - Phone:504-889-9893
Mailing Address - Fax:504-889-9895
Practice Address - Street 1:3800 HOUMA BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006
Practice Address - Country:US
Practice Address - Phone:504-889-9893
Practice Address - Fax:504-889-9895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1880213Medicaid
LA1880213Medicaid