Provider Demographics
NPI:1336880996
Name:NOLA PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:NOLA PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTOFFER
Authorized Official - Middle Name:
Authorized Official - Last Name:NORBO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:504-420-6652
Mailing Address - Street 1:7030 CANAL BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-3410
Mailing Address - Country:US
Mailing Address - Phone:504-420-6652
Mailing Address - Fax:
Practice Address - Street 1:7030 CANAL BLVD STE 120
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70124-3410
Practice Address - Country:US
Practice Address - Phone:504-420-6652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental