Provider Demographics
NPI:1720852973
Name:STEPHANIE BARLOW DDS LLC
Entity Type:Organization
Organization Name:STEPHANIE BARLOW DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:F
Authorized Official - Last Name:BARLOW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:864-641-5511
Mailing Address - Street 1:102 FONTAINBLEAU DR STE F2
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-6519
Mailing Address - Country:US
Mailing Address - Phone:985-317-0656
Mailing Address - Fax:
Practice Address - Street 1:102 FONTAINBLEAU DR STE F2
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-6519
Practice Address - Country:US
Practice Address - Phone:985-317-0656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1063865285Medicaid
LA1255627303Medicaid