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Organization
SOUTHERN DENTAL CARE, LLC
Active
Organization
SOUTHERN DENTAL CARE, LLC
Active
Other names
Southern Dental Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LACEY ADDISON ANDREOTTA DDS (OWNER, DENTIST)
(504) 347-1014
Entity
Organization
Contact information
Practice address
7301 WESTBANK EXPY, MARRERO, LA 70072-2448
(504) 347-1014
Mailing address
35330 BOND DR, SLIDELL, LA 70460-6136
(985) 707-9122
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6350
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1863505
—
LA
Enumeration date
04/29/2014
Last updated
04/29/2014
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