Provider Demographics
NPI:1154036291
Name:CFDM LLC
Entity type:Organization
Organization Name:CFDM LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREOTTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:504-455-5410
Mailing Address - Street 1:2636 ATHANIA PKWY
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002
Mailing Address - Country:US
Mailing Address - Phone:504-455-5410
Mailing Address - Fax:504-455-5410
Practice Address - Street 1:2636 ATHANIA PKWY
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002
Practice Address - Country:US
Practice Address - Phone:504-455-5410
Practice Address - Fax:504-455-5410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-23
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1863505Medicaid