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General NPI Number Information
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NPI Number | 1770028946
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Entity Type | Organization
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Legal Business Name | CUDDLE KIDS DENTAL CARE OF SHREVEPORT, LLC
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Dates
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Enumeration Date | 12/27/2016
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Last Update Date | 12/27/2016
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Provider Practice Location Address
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Address Line | 2433 E 70TH ST SUITE A
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City | SHREVEPORT
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State | LA
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Zip | 71105-4787
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Country | US
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Telephone | 318-564-0595
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Fax |
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Provider Business Mailing Address
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Address Line | 2433 E 70TH ST SUITE A
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City | SHREVEPORT
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State | LA
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Zip | 71105-4787
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Country | US
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Telephone | 318-564-0595
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC DENTIST/OWNER
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Name | DR. CHRISHELLE WILLIAMS HEMPHILL
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Credential | D.D.S., M.B.A.
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Telephone | 318-564-0595
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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 | 6416
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License Number State | LA
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