Provider Demographics
NPI:1861587099
Name:VANCE G MISURACA DDS LLC
Entity type:Organization
Organization Name:VANCE G MISURACA DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VANCE
Authorized Official - Middle Name:G
Authorized Official - Last Name:MISURACA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS UC
Authorized Official - Phone:225-766-3300
Mailing Address - Street 1:10720 N OAK HILLS PKWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810
Mailing Address - Country:US
Mailing Address - Phone:225-766-3300
Mailing Address - Fax:225-766-3387
Practice Address - Street 1:10720 N OAK HILLS PKWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810
Practice Address - Country:US
Practice Address - Phone:225-766-3300
Practice Address - Fax:225-766-3387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4721122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty