Healthcare Provider Details

I. General information

NPI: 1770028946
Provider Name (Legal Business Name): CUDDLE KIDS DENTAL CARE OF SHREVEPORT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2016
Last Update Date: 12/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2433 E 70TH ST SUITE A
SHREVEPORT LA
71105-4787
US

IV. Provider business mailing address

2433 E 70TH ST SUITE A
SHREVEPORT LA
71105-4787
US

V. Phone/Fax

Practice location:
  • Phone: 318-564-0595
  • Fax:
Mailing address:
  • Phone: 318-564-0595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number6416
License Number StateLA

VIII. Authorized Official

Name: DR. CHRISHELLE WILLIAMS HEMPHILL
Title or Position: PEDIATRIC DENTIST/OWNER
Credential: D.D.S., M.B.A.
Phone: 318-564-0595