Organization
MONTICELLO FAMILY DENTAL CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THUONG - TRI DINH NGUYEN D.D.S. (OWNER)
(225) 275-4665
Entity
Organization
Contact information
Practice address
4814 MONTICELLO BLVD, BATON ROUGE, LA 70814
(225) 275-4665
(225) 274-8906
Mailing address
4814 MONTICELLO BLVD, BATON ROUGE, LA 70814
(225) 275-4665
(225) 274-8906
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5420
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1854204
—
LA
Enumeration date
11/16/2012
Last updated
11/16/2012
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