Provider Demographics
NPI:1578389987
Name:CHILDREN AND FAMILY DENTIST LLC
Entity type:Organization
Organization Name:CHILDREN AND FAMILY DENTIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FAWWAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:ALOTAIBI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:404-431-9587
Mailing Address - Street 1:3501 HOLIDAY DR STE 101
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70114-8260
Mailing Address - Country:US
Mailing Address - Phone:404-431-9587
Mailing Address - Fax:
Practice Address - Street 1:3501 HOLIDAY DR STE 101
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114-8260
Practice Address - Country:US
Practice Address - Phone:404-431-9587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty