Healthcare Provider Details

I. General information

NPI: 1265642896
Provider Name (Legal Business Name): JERALD FORREST TURNER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2915 PLANTATION DRIVE
BOSSIER CITY LA
71111
US

IV. Provider business mailing address

9818 PAGEANT LN
SHREVEPORT LA
71115-4504
US

V. Phone/Fax

Practice location:
  • Phone: 318-742-1602
  • Fax:
Mailing address:
  • Phone: 318-798-9865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number5593
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: