Provider Demographics
NPI:1992960637
Name:PERIODONTAL HEALTH SPECIALISTS, LLC
Entity type:Organization
Organization Name:PERIODONTAL HEALTH SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AYMEE
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTALES-SPINDLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:504-887-8205
Mailing Address - Street 1:2540 SEVERN AVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-5954
Mailing Address - Country:US
Mailing Address - Phone:504-887-8205
Mailing Address - Fax:
Practice Address - Street 1:2540 SEVERN AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-5954
Practice Address - Country:US
Practice Address - Phone:504-887-8205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3763261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental