Provider Demographics
NPI:1699910869
Name:FALLIN AND FALLIN FAMILY DENTISTRY COURSEY, LLC
Entity type:Organization
Organization Name:FALLIN AND FALLIN FAMILY DENTISTRY COURSEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:FALLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:225-654-2212
Mailing Address - Street 1:13707 COURSEY BLVD
Mailing Address - Street 2:#A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-1306
Mailing Address - Country:US
Mailing Address - Phone:225-752-5241
Mailing Address - Fax:225-752-8691
Practice Address - Street 1:13707 COURSEY BLVD
Practice Address - Street 2:#A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-1306
Practice Address - Country:US
Practice Address - Phone:225-752-5241
Practice Address - Fax:225-752-8691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4954261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental