Provider Demographics
NPI:1912407842
Name:MATURIN PEDIATRIC DENTISTRY LLC
Entity Type:Organization
Organization Name:MATURIN PEDIATRIC DENTISTRY LLC
Other - Org Name:ASCENSION CHILDREN'S DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MATTURIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:225-402-4118
Mailing Address - Street 1:14639 AIRLINE HWY STE 111
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-6632
Mailing Address - Country:US
Mailing Address - Phone:225-402-4118
Mailing Address - Fax:
Practice Address - Street 1:14639 AIRLINE HWY STE 111
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-6632
Practice Address - Country:US
Practice Address - Phone:225-402-4118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty