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General NPI Number Information
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NPI Number | 1568842987
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Entity Type | Organization
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Legal Business Name | TWINKLINGSMILES OF OAKDALE
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Dates
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Enumeration Date | 06/01/2015
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Last Update Date | 06/02/2015
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Provider Practice Location Address
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Address Line | 200 N 15TH ST
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City | OAKDALE
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State | LA
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Zip | 71463-2732
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Country | US
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Telephone | 202-215-4731
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Fax |
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Provider Business Mailing Address
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Address Line | 200 N 15TH ST
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City | OAKDALE
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State | LA
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Zip | 71463-2732
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | DR. KATINA RENE BEVERLY
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Credential |
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Telephone | 12022154731
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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 | 5857
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 5856
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License Number State | LA
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