Provider Demographics
NPI:1609228428
Name:EXCEPTIONAL DENTAL OF SLIDELL
Entity type:Organization
Organization Name:EXCEPTIONAL DENTAL OF SLIDELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELSY
Authorized Official - Middle Name:
Authorized Official - Last Name:CABRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-643-2616
Mailing Address - Street 1:101 SMART PL
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2039
Mailing Address - Country:US
Mailing Address - Phone:985-643-2616
Mailing Address - Fax:
Practice Address - Street 1:101 SMART PL
Practice Address - Street 2:SUITE B
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2039
Practice Address - Country:US
Practice Address - Phone:985-643-2616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-05
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty