Organization
NORTHLAKE DENTAL LLC
Active
Other names
Northlake Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PATRICK SHANNON ALLISON DDS (OWNER)
(985) 626-3338
Entity
Organization
Contact information
Practice address
2030 N CAUSEWAY BLVD, MANDEVILLE, LA 70471-3116
(985) 626-3338
(985) 626-3318
Mailing address
2030 N CAUSEWAY BLVD, MANDEVILLE, LA 70471-3116
(985) 626-3338
(985) 626-3318
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A2169
BLUE CROSS BLUE SHIELD
LA
01
—
H2632
BLUE CROSS BLUE SHIELD
LA
Enumeration date
05/30/2008
Last updated
07/31/2020
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