Exceptional Dental of Mid City LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

EXCEPTIONAL DENTAL OF MID CITY LLC

Practice address

4141 Bienville St
Suite 105
New Orleans, LA 70119-5149

Phone

(504) 232-6624

Fax

(504) 340-7207

NPI assigned

Dec 8, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Darrell P B Jr., DDS

Title

Owner

Phone

(504) 232-6624

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Darrell P Bourg Jr., D.D.S.

  • General Practice Dentistry
  • Marrero, LA
  • NPI 1215053558
  NPD (past)
• Jacob Charles McInnis, D.D.S.

  • General Practice Dentistry
  • Kenner, LA
  • NPI 1881957421
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1449532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449532800000",
    "number": "1386019909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4141 BIENVILLE ST",
            "address_2": "SUITE 105",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701195149",
            "telephone_number": "504-232-6624",
            "fax_number": "504-340-7207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4141 BIENVILLE ST",
            "address_2": "SUITE 105",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701195149",
            "telephone_number": "504-232-6624",
            "fax_number": "504-340-7207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCEPTIONAL DENTAL OF MID CITY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-08",
        "last_updated": "2015-12-08",
        "status": "A",
        "authorized_official_last_name": "B",
        "authorized_official_first_name": "DARRELL",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "504-232-6624",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Excelth, Incorporated
• Exceptional Dental of Uptown, LLC
• Executive Medicine LLC
• Executive Medicine, LLC
• Aubrey Anne Exnicios, DDS
• Exodus House, LLC

• General Practice Dentistry in New Orleans, LA
• Providers in New Orleans, LA by specialty
• General Practice Dentistry in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.