Provider Demographics
NPI:1306460001
Name:BFD MADISONVILLE ASSOCIATES LLC
Entity type:Organization
Organization Name:BFD MADISONVILLE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:TINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:985-590-5175
Mailing Address - Street 1:109 PINE CREEK DRIVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447
Mailing Address - Country:US
Mailing Address - Phone:985-590-5175
Mailing Address - Fax:985-590-5165
Practice Address - Street 1:109 PINE CREEK DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:MADISONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70447
Practice Address - Country:US
Practice Address - Phone:985-590-5175
Practice Address - Fax:985-590-5165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty