Provider Demographics
NPI:1396991980
Name:GREAT OAKS DENTAL CARE
Entity type:Organization
Organization Name:GREAT OAKS DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:THORNTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:225-767-3130
Mailing Address - Street 1:11920 PERKINS RD
Mailing Address - Street 2:STE A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-0800
Mailing Address - Country:US
Mailing Address - Phone:225-767-3130
Mailing Address - Fax:225-767-3994
Practice Address - Street 1:11920 PERKINS RD
Practice Address - Street 2:STE A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-0800
Practice Address - Country:US
Practice Address - Phone:225-767-3130
Practice Address - Fax:225-767-3994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service