COUNTRY CLUB DENTAL NPI 1003970682

NPI Information

  • NPI: 1003970682
  • Provider Name: COUNTRY CLUB DENTAL
  • Classification: Dentist - 1223G0001X
  • Specialization: General Practice
  • Entity Type: Organization
  • Doing Business As: LOUISIANA DENTAL SPA
  • Address: 16645 HIGHLAND RD STE J
    BATON ROUGE, LA
    ZIP 70810
  • Phone: (225) 214-0100

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NPI Details

COUNTRY CLUB DENTAL is a general practice dentist in Baton Rouge, LA. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. COUNTRY CLUB DENTAL NPI is 1003970682. The provider is registered as an organization entity type and is a multiple single specialty group.
The provider Is Doing Business As Louisiana Dental Spa.

The provider's business location address is:

16645 HIGHLAND RD STE J
BATON ROUGE, LA
ZIP 70810-567
Phone: (225) 214-0100
Fax: (225) 214-0103

The provider's authorized official is Darrell Paul Bourg .
The authorized official title is Dentist and has the following contact phone number (504) 232-6624.

The enumeration date for this NPI number is 12/20/2006 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223G0001XDentistGeneral Practice5312LOUISIANAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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