Organization
NORTHSHORE ORTHODONTICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. REBECCA PAYNE DDS, MS (OWNER)
(985) 626-0160
Entity
Organization
Contact information
Practice address
4010 LONESOME RD, MANDEVILLE, LA 70448-7085
(985) 626-0160
(985) 727-4459
Mailing address
4010 LONESOME RD, MANDEVILLE, LA 70448-7085
(985) 626-0160
(985) 727-4459
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
6567
LA
Other
Enumeration date
07/12/2017
Last updated
03/17/2018
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