Provider Demographics
NPI:1063703122
Name:BERTHELOT AND ASSOCIATES, LLC
Entity type:Organization
Organization Name:BERTHELOT AND ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BERTHELOT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:225-364-3640
Mailing Address - Street 1:6711 HIGHWAY 1 SOUTH
Mailing Address - Street 2:
Mailing Address - City:ADDIS
Mailing Address - State:LA
Mailing Address - Zip Code:70710
Mailing Address - Country:US
Mailing Address - Phone:225-364-3640
Mailing Address - Fax:225-364-3643
Practice Address - Street 1:6711 HIGHWAY 1 SOUTH
Practice Address - Street 2:
Practice Address - City:ADDIS
Practice Address - State:LA
Practice Address - Zip Code:70710
Practice Address - Country:US
Practice Address - Phone:225-364-3640
Practice Address - Fax:225-364-3643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6031261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental