Provider Demographics
NPI:1063055655
Name:APPLE ST DENTAL LLC
Entity type:Organization
Organization Name:APPLE ST DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BESSONET
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:504-905-9887
Mailing Address - Street 1:120 APPLE ST
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:LA
Mailing Address - Zip Code:70079-2216
Mailing Address - Country:US
Mailing Address - Phone:985-764-7066
Mailing Address - Fax:
Practice Address - Street 1:120 APPLE ST
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:LA
Practice Address - Zip Code:70079-2216
Practice Address - Country:US
Practice Address - Phone:985-764-7066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty