Provider Demographics
NPI:1588135404
Name:NORTHSHORE DENTAL ASSOCIATES LLC
Entity type:Organization
Organization Name:NORTHSHORE DENTAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHAWLA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:985-774-8104
Mailing Address - Street 1:1160 HIGHWAY 51
Mailing Address - Street 2:
Mailing Address - City:PONCHATOULA
Mailing Address - State:LA
Mailing Address - Zip Code:70454-6365
Mailing Address - Country:US
Mailing Address - Phone:985-386-9936
Mailing Address - Fax:985-386-5712
Practice Address - Street 1:1160 HIGHWAY 51
Practice Address - Street 2:
Practice Address - City:PONCHATOULA
Practice Address - State:LA
Practice Address - Zip Code:70454-6365
Practice Address - Country:US
Practice Address - Phone:985-386-9936
Practice Address - Fax:985-386-5712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental