Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Country Club Dental

Organization General Practice Dentistry · NPI 1003970682

Country Club Dental is a General Practice Dentistry in Baton Rouge, Louisiana. Licensed in Louisiana. Registered with an NPI since 2006.

Licensed in
LA
In the registry since
2006

Practice location Address checks out

16645 Highland Rd Ste J
Baton Rouge, LA 70810-6567
Phone: (225) 214-0100
Fax: (225) 214-0103
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Dentistry (primary) Taxonomy 1223G0001X · Licence 5312 (LA)

Record details

NPI number1003970682
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Darrell Bourg — Dentist · (504) 232-6624
Other names Louisiana Dental Spa
NPI enumeratedDecember 20, 2006
Last updated in NPPESAugust 22, 2020
Mailing address16645 Highland Rd Ste J, Baton Rouge, LA 70810-6567

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