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Organization
PINECREST DEVELOPMENTAL CENTER
Active
Organization
PINECREST DEVELOPMENTAL CENTER
Active
Parent organization
PINECREST DEVELOPMENTAL CENTER
Other names
Pinecrest Dental Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
PINECREST DEVELOPMENTAL CENTER
Authorized official
MR. PAXTON E. OLIVER II M.S. (MR/DD REGIONAL ASSOC. ADMINISTRATOR)
(318) 487-5395
Entity
Organization
Contact information
Practice address
100 PINECREST DR, ATTN: PAXTON OLIVER, PINEVILLE, LA 71360-4276
(318) 487-5395
(318) 487-5463
Mailing address
PO BOX 5191, ATTN; PAXTON OLIVER, PINEVILLE, LA 71361-5191
(318) 487-5395
(318) 487-5463
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
LA
Other
Enumeration date
12/09/2009
Last updated
12/09/2009
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