Healthcare Provider Details

I. General information

NPI: 1992390793
Provider Name (Legal Business Name): ALEXANDRIA SMILE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2021
Last Update Date: 03/07/2021
Certification Date: 03/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3511 PARLIAMENT CT
ALEXANDRIA LA
71303-3135
US

IV. Provider business mailing address

3511 PARLIAMENT CT
ALEXANDRIA LA
71303-3135
US

V. Phone/Fax

Practice location:
  • Phone: 318-545-7606
  • Fax: 318-545-7626
Mailing address:
  • Phone: 318-545-7606
  • Fax: 318-545-7626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN THOMAS MOYLAN III
Title or Position: OWNER/MEMBER
Credential: DDS
Phone: 318-545-7606