Provider Demographics
NPI:1952731705
Name:DOCTORS DENTAL 06, LLC
Entity Type:Organization
Organization Name:DOCTORS DENTAL 06, LLC
Other - Org Name:DOCTORS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:DAVENPORT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:985-768-4520
Mailing Address - Street 1:601 RIVER HIGHLANDS BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-8987
Mailing Address - Country:US
Mailing Address - Phone:985-768-4520
Mailing Address - Fax:985-310-7414
Practice Address - Street 1:730 VETERANS BLVD SUITE B
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005
Practice Address - Country:US
Practice Address - Phone:985-768-4520
Practice Address - Fax:985-310-7414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-14
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5713261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental