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General NPI Number Information
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NPI Number | 1528615887
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Entity Type | Organization
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Legal Business Name | BENJAMIN A. BEACH DDS AND ROSS H. DIES DDS MIDCITY, LLC
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Dates
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Enumeration Date | 08/21/2019
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Last Update Date | 08/21/2019
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Provider Practice Location Address
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Address Line | 8510 LINE AVE STE A
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City | SHREVEPORT
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State | LA
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Zip | 71106-6119
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Country | US
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Telephone | 318-686-7470
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Fax |
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Provider Business Mailing Address
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Address Line | 8510 LINE AVE STE A
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City | SHREVEPORT
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State | LA
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Zip | 71106-6119
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Country | US
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Telephone | 318-686-7470
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | LINDSEY COPE
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Credential | RHD
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Telephone | 318-213-4686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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