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General NPI Number Information
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NPI Number | 1558723312
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Entity Type | Organization
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Legal Business Name | A G FAMILY DENTISTRY LLC
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Dates
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Enumeration Date | 03/22/2016
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Last Update Date | 03/22/2016
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Provider Practice Location Address
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Address Line | 4017 PARLIAMENT DR ST B
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City | ALEXANDIRA
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State | LA
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Zip | 71303-3018
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Country | US
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Telephone | 318-442-4430
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Fax | 318-442-7705
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Provider Business Mailing Address
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Address Line | 4017 PARLIAMENT DR ST B
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City | ALEXANDIRA
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State | LA
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Zip | 71303-3018
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Country | US
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Telephone | 318-442-4430
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Fax | 318-442-7705
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Authorized Official
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Title or Position | OWNER
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Name | ANIL K GUPTA
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Credential |
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Telephone | 318-442-4430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6354
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License Number State | LA
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