Provider Demographics
NPI:1457185514
Name:WAMPOLD FAMILY DENTISTRY
Entity type:Organization
Organization Name:WAMPOLD FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:EVAN
Authorized Official - Last Name:WAMPOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:225-927-5445
Mailing Address - Street 1:7179 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-8114
Mailing Address - Country:US
Mailing Address - Phone:225-927-5445
Mailing Address - Fax:225-927-4871
Practice Address - Street 1:7179 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-8114
Practice Address - Country:US
Practice Address - Phone:225-927-5445
Practice Address - Fax:225-927-4871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental