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General NPI Number Information
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NPI Number | 1639607104
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Entity Type | Organization
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Legal Business Name | LOUD FAMILY DENTAL
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Dates
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Enumeration Date | 05/30/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2701 FREDERICK ST
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City | SHREVEPORT
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State | LA
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Zip | 71109-3607
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Country | US
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Telephone | 318-631-3464
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Fax | 318-631-3474
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Provider Business Mailing Address
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Address Line | 2701 FREDERICK ST
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City | SHREVEPORT
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State | LA
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Zip | 71109-3607
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Country | US
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Telephone | 318-631-3464
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Fax | 318-631-3474
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MISS AHIDA OCHILL
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Credential |
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Telephone | 318-631-3464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6613
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5534
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License Number State | LA
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