# COSMETIC DENTISTRY OF BATON ROUGE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134345184
- **Authorized official:** MARK ANDREW VENTRESS DDS (OWNER)
- **Authorized official phone:** (225) 926-8954

## Contact information

- **Practice address:** 632 SHADOWS LN, SUITE B, BATON ROUGE, LA 70806-6532
- **Practice address phone:** (225) 926-8954
- **Practice address fax:** (225) 927-4055
- **Mailing address:** 632 SHADOWS LN, SUITE B, BATON ROUGE, LA 70806-6532
- **Mailing address phone:** (225) 926-8954
- **Mailing address fax:** (225) 927-4055

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 5147 | LA | Yes |

## Other

- **Enumeration date:** 04/18/2007
- **Last updated:** 08/22/2020