Basic Information
| Provider Information | |||||||||
| NPI: | 1568880250 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HO | ||||||||
| FirstName: | ALICE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4508 CHATEAU DR | ||||||||
| Address2: | |||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700021510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5042418457 | ||||||||
| FaxNumber: | 5042418540 | ||||||||
| Practice Location | |||||||||
| Address1: | 4141 BIENVILLE ST | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701195149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5049001195 | ||||||||
| FaxNumber: | 5045132062 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2014 | ||||||||
| LastUpdateDate: | 04/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 6498 | LA | Y | Dental Providers | Dentist | General Practice |
No ID Information.