Organization
THORSON DENTISTRY FOR KIDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOEY KEENER (OFFICE MANAGER)
(985) 307-0072
Entity
Organization
Contact information
Practice address
159 LONGVIEW DR STE A, DESTREHAN, LA 70047
(985) 307-0072
Mailing address
159 LONGVIEW DR STE A, DESTREHAN, LA 70047-5076
(985) 307-0072
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861227
—
LA
05
—
26622
—
LA
05
—
28782
—
LA
01
—
6122
STATE LICENSE
LA
Enumeration date
08/07/2018
Last updated
08/15/2018
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