Provider Demographics
NPI:1508658303
Name:CUSCO, CAMILLE ELISE (DDS)
Entity type:Individual
Prefix:DR
First Name:CAMILLE
Middle Name:ELISE
Last Name:CUSCO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2018 CARTER AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-8407
Mailing Address - Country:US
Mailing Address - Phone:504-289-8455
Mailing Address - Fax:
Practice Address - Street 1:9069 SIEGEN LN
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-1951
Practice Address - Country:US
Practice Address - Phone:225-479-1570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA76621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice