Provider Demographics
NPI:1881141638
Name:FRENCH QUARTER FAMILY DENTISTRY LLC
Entity type:Organization
Organization Name:FRENCH QUARTER FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:MOURSELAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:239-530-4000
Mailing Address - Street 1:501 GOODLETTE RD N
Mailing Address - Street 2:SUITE B 202
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5661
Mailing Address - Country:US
Mailing Address - Phone:239-530-4000
Mailing Address - Fax:239-530-4025
Practice Address - Street 1:501 GOODLETTE RD N
Practice Address - Street 2:SUITE B 202
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5661
Practice Address - Country:US
Practice Address - Phone:239-530-4000
Practice Address - Fax:239-530-4025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN167931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty