Provider Demographics
NPI:1043064074
Name:B&L DENTAL, LLC
Entity type:Organization
Organization Name:B&L DENTAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:318-248-4986
Mailing Address - Street 1:902 JULIA ST
Mailing Address - Street 2:
Mailing Address - City:RAYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71269-2618
Mailing Address - Country:US
Mailing Address - Phone:318-728-8773
Mailing Address - Fax:318-728-8787
Practice Address - Street 1:902 JULIA ST
Practice Address - Street 2:
Practice Address - City:RAYVILLE
Practice Address - State:LA
Practice Address - Zip Code:71269-2618
Practice Address - Country:US
Practice Address - Phone:318-728-8773
Practice Address - Fax:318-728-8787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty