Provider Demographics
NPI:1730625468
Name:RICHARD M. RATHKE JR. LLC
Entity type:Organization
Organization Name:RICHARD M. RATHKE JR. LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:RATHKE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:985-774-6193
Mailing Address - Street 1:307 TCHOUPITOULAS ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70130-2432
Mailing Address - Country:US
Mailing Address - Phone:504-528-7800
Mailing Address - Fax:504-528-7801
Practice Address - Street 1:307 TCHOUPITOULAS ST
Practice Address - Street 2:SUITE 200
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70130-2432
Practice Address - Country:US
Practice Address - Phone:504-528-7800
Practice Address - Fax:504-528-7801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA63121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty