Organization
EDWARD C MASSETT JR. DDS APC
Active
Organization
EDWARD C MASSETT JR. DDS APC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHRISTOPHER BRADLEY DICKERSON D.D.S., M.D. (OWNER)
(985) 641-2030
Entity
Organization
Contact information
Practice address
2334 GAUSE BLVD E, SLIDELL, LA 70461-4141
(985) 641-2030
(985) 645-0272
Mailing address
2334 GAUSE BLVD. EAST, SLIDELL, LA 70461
(985) 641-2030
(985) 645-0272
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
2368
LA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1823686
—
LA
05
—
1857149
—
LA
Enumeration date
08/25/2016
Last updated
08/25/2016
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