Provider Demographics
NPI:1699541003
Name:RABORN DENTAL GREENWELL SPRINGS LLC
Entity type:Organization
Organization Name:RABORN DENTAL GREENWELL SPRINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/ MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:RABORN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:225-405-4997
Mailing Address - Street 1:7604 CLARET AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-1584
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14127 GREENWELL SPRINGS RD
Practice Address - Street 2:
Practice Address - City:GREENWELL SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70739-3305
Practice Address - Country:US
Practice Address - Phone:225-460-2165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental