Organization
SOUTHERN DENTAL CARE, LLC
Active
Other names
Southern Dental Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LACEY ADDISON ANDREOTTA DDS (OWNER, DENTIST)
(504) 347-1014
Entity
Organization
Contact information
Practice address
7301 WESTBANK EXPY, MARRERO, LA 70072-2448
(504) 347-1014
Mailing address
35330 BOND DR, SLIDELL, LA 70460-6136
(985) 707-9122
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6350
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1863505
—
LA
Enumeration date
04/29/2014
Last updated
04/29/2014
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