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Organization
SENIOR DENTAL CARE OF LOUISIANA
Active
Organization
SENIOR DENTAL CARE OF LOUISIANA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TONY LAYNE (MANAGER)
(850) 398-4500
Entity
Organization
Contact information
Practice address
16119 STATE ROAD 71 S, BLOUNTSTOWN, FL 32424-2810
(850) 398-4500
Mailing address
PO BOX 367, BLOUNTSTOWN, FL 32424-0367
(850) 398-4500
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
03/12/2013
Last updated
02/22/2017
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