Healthcare Provider Details

I. General information

NPI: 1427054303
Provider Name (Legal Business Name): JOSEPH HARRISON BUMGARDNER JR. D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2312 MILL ST
RINGGOLD LA
71068-2876
US

IV. Provider business mailing address

PO BOX 685
RINGGOLD LA
71068-0685
US

V. Phone/Fax

Practice location:
  • Phone: 318-894-4925
  • Fax: 318-894-9328
Mailing address:
  • Phone: 318-894-4925
  • Fax: 318-894-9328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4054
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: