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General NPI Number Information
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NPI Number | 1407098619
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Entity Type | Organization
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Legal Business Name | ALEXANDRIA PEDIATRIC DENTISTRY - A PARTNERSHIP
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Dates
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Enumeration Date | 04/02/2009
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Last Update Date | 04/02/2009
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Provider Practice Location Address
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Address Line | 1400 METRO DR STE A
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City | ALEXANDRIA
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State | LA
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Zip | 71301-3451
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Country | US
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Telephone | 318-445-5471
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Fax | 318-445-5901
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Provider Business Mailing Address
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Address Line | 1400 METRO DR STE A
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City | ALEXANDRIA
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State | LA
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Zip | 71301-3451
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Country | US
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Telephone | 318-445-5471
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Fax | 318-445-5901
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Authorized Official
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Title or Position | PARTNER
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Name | DR. RICHARD R BRASHER JR.
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Credential | DDS
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Telephone | 318-445-5471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 2193
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License Number State | LA
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