Provider Demographics
NPI:1932228418
Name:SLIDELL DENTAL ASSOCIATE, LLC
Entity Type:Organization
Organization Name:SLIDELL DENTAL ASSOCIATE, LLC
Other - Org Name:LOUISIANA DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:LACOSTE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:985-345-0240
Mailing Address - Street 1:1301 EASTRIDGE DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-3018
Mailing Address - Country:US
Mailing Address - Phone:985-643-8800
Mailing Address - Fax:
Practice Address - Street 1:1301 EASTRIDGE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-3018
Practice Address - Country:US
Practice Address - Phone:985-643-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty