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General NPI Number Information
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NPI Number | 1154859320
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Entity Type | Organization
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Legal Business Name | SOUTHERN ROOT DENTISTRY LLC
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Dates
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Enumeration Date | 05/31/2017
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Last Update Date | 01/13/2026
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Provider Practice Location Address
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Address Line | 734 N ASHLEY RIDGE LOOP
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City | SHREVEPORT
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State | LA
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Zip | 71106
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Country | US
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Telephone | 318-701-8885
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Fax | 318-701-8887
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Provider Business Mailing Address
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Address Line | 734 N ASHLEY RIDGE LOOP
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City | SHREVEPORT
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State | LA
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Zip | 71106
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Country | US
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Telephone | 318-701-8885
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Fax | 318-701-8887
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES DANIEL LOWDER
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Credential | DDS
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Telephone | 318-272-9835
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6750
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6747
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License Number State | LA
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