Provider Demographics
NPI:1528311768
Name:BLUEBONNET DENTAL CARE @ MILLBROOK
Entity type:Organization
Organization Name:BLUEBONNET DENTAL CARE @ MILLBROOK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JARREAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-767-2273
Mailing Address - Street 1:4210 HIGHWAY 14
Mailing Address - Street 2:
Mailing Address - City:MILLBROOK
Mailing Address - State:AL
Mailing Address - Zip Code:36054-1951
Mailing Address - Country:US
Mailing Address - Phone:225-767-2273
Mailing Address - Fax:225-769-3395
Practice Address - Street 1:4451 BLUEBONNET BLVD
Practice Address - Street 2:STE F
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-9646
Practice Address - Country:US
Practice Address - Phone:225-767-2273
Practice Address - Fax:225-769-3395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty