Organization
DISTINCTIVE SMILES OF BATON ROUGE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SANCERIE J O'ROURKE -ALLEN (PRESIDENT)
(225) 218-9218
Entity
Organization
Contact information
Practice address
8894 AIRLINE HWY, SUITE M, BATON ROUGE, LA 70815-4081
(225) 218-9218
(225) 218-9219
Mailing address
8894 AIRLINE HWY, SUITE M, BATON ROUGE, LA 70815-4081
(225) 218-9218
(225) 218-9219
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5131
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1851311
—
LA
Enumeration date
03/20/2007
Last updated
12/09/2009
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