Provider Demographics
NPI:1952760100
Name:DR. ROBERT J. SPEARS FAMILY DENTISTRY
Entity type:Organization
Organization Name:DR. ROBERT J. SPEARS FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SPEARS
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS
Authorized Official - Phone:504-241-8214
Mailing Address - Street 1:9235 LAKE FOREST BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70127-3043
Mailing Address - Country:US
Mailing Address - Phone:504-241-8214
Mailing Address - Fax:504-241-2246
Practice Address - Street 1:9235 LAKE FOREST BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-3043
Practice Address - Country:US
Practice Address - Phone:504-241-8214
Practice Address - Fax:504-241-2246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1835994Medicaid
LA2378414Medicaid