Organization
EXCEPTIONAL DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE COOK (OFFICE MANAGER)
(504) 433-2092
Entity
Organization
Contact information
Practice address
27136 HIGHWAY 23, SUITE 314, PORT SULPHUR, LA 70083-2648
(504) 433-2092
Mailing address
27136 HIGHWAY 23, SUITE 314, PORT SULPHUR, LA 70083-2648
(504) 433-2092
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
LA
Other
Enumeration date
07/15/2015
Last updated
07/15/2015
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