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Organization
NORTHLAKE DENTAL LLC
Active
Organization
NORTHLAKE DENTAL LLC
Active
Other names
Northlake Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PATRICK SHANNON ALLISON DDS (OWNER)
(985) 626-3338
Entity
Organization
Contact information
Practice address
2030 N CAUSEWAY BLVD, MANDEVILLE, LA 70471-3116
(985) 626-3338
(985) 626-3318
Mailing address
2030 N CAUSEWAY BLVD, MANDEVILLE, LA 70471-3116
(985) 626-3338
(985) 626-3318
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A2169
BLUE CROSS BLUE SHIELD
LA
01
—
H2632
BLUE CROSS BLUE SHIELD
LA
Enumeration date
05/30/2008
Last updated
07/31/2020
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