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LOUISIANA DENTAL SPA
NPI 1003970682
Dentist - General Practice in Baton Rouge, LA

Active since December 20, 2006
16645 HIGHLAND RD STE J, BATON ROUGE, LA 70810(225) 214-0100(225) 214-0103 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Louisiana Dental Spa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LOUISIANA DENTAL SPA (NPI 1003970682) is a healthcare organization registered as a general practice in Baton Rouge, Louisiana and active in the NPI registry since December 2006. The organization lists Darrell Paul Bourg, Dentist, as its authorized official.

NPPES Registry Identity

NPI1003970682
Entity TypeOrganization
Primary Taxonomy1223G0001X
Legal Business NameCOUNTRY CLUB DENTAL
Location Address16645 HIGHLAND RD STE JBaton Rouge, LA 70810-6567
Mailing Address16645 Highland Rd Ste JBaton Rouge, LA 70810-6567 · (225) 214-0100 · Fax (225) 214-0103
Phone(225) 214-0100
Fax(225) 214-0103
Organization SubpartNo
Authorized OfficialDarrell Paul BourgDentist · (504) 232-6624
Enumeration DateDecember 20, 2006
Last NPPES UpdateAugust 22, 2020
✔ NPI 1003970682 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
License✔ Licensed in LA · 5312
Definition
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.
16645 HIGHLAND RD STE J, Baton Rouge, LA 70810
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Other Names 1

Doing Business AsLouisiana Dental Spa

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. ROBIN CHATMAN SHANNON DDS
Dentist (General Practice)
16645 HIGHLAND RD STE J
BATON ROUGE, LA 70810
East Baton Rouge Parish (225) 214-0100
DR. TYLER PAUL LASSEIGNE
Dentist (Prosthodontics)
16645 HIGHLAND RD STE J
BATON ROUGE, LA 70810
East Baton Rouge Parish (225) 214-0100
ESTHETIC ASSOCIATES LLC
Dentist
16645 HIGHLAND RD STE J
BATON ROUGE, LA 70810
East Baton Rouge Parish (504) 416-7440

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Country Club Dental's NPI number?

The NPI number for Country Club Dental is 1003970682. It was assigned to this organization in the NPPES registry on December 20, 2006. The provider is doing business as Louisiana Dental Spa.

Where is Country Club Dental located?

Country Club Dental is located at 16645 Highland Rd Ste J, Baton Rouge, LA 70810. The listed phone number is (225) 214-0100.

What is Country Club Dental's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

When was this NPI record last updated?

The NPPES record for Country Club Dental was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.