=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477400745
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TSD KENDALL & GENGEL SHREVEPORT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2026
-----------------------------------------------------
Last Update Date | 03/14/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4354 PINES RD
-----------------------------------------------------
City | SHREVEPORT
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71119-7738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-635-1970
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4354 PINES RD
-----------------------------------------------------
City | SHREVEPORT
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71119-7738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-635-1970
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. AMBER HALLUM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 903-758-5551
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------