Provider Demographics
NPI:1154402261
Name:SUADI, CARLOS MIGUEL (DDS)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:MIGUEL
Last Name:SUADI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15420 SOUTH HARRELLS FERRY RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-2940
Mailing Address - Country:US
Mailing Address - Phone:225-753-5885
Mailing Address - Fax:225-753-5908
Practice Address - Street 1:15420 SOUTH HARRELLS FERRY RD
Practice Address - Street 2:SUITE C
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2940
Practice Address - Country:US
Practice Address - Phone:225-753-5885
Practice Address - Fax:225-753-5908
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA48181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
856322OtherUNITED CONCORDIA
LA1848182Medicaid