Healthcare Provider Details

I. General information

NPI: 1649116872
Provider Name (Legal Business Name): SR STONEWALL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4974 HIGHWAY 3276 STE G
STONEWALL LA
71078-9306
US

IV. Provider business mailing address

734 N ASHLEY RIDGE LOOP
SHREVEPORT LA
71106-7209
US

V. Phone/Fax

Practice location:
  • Phone: 318-775-5422
  • Fax:
Mailing address:
  • Phone: 318-701-8885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES DAVID LOWDER
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 318-272-9835