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General NPI Number Information
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NPI Number | 1922235597
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Entity Type | Individual
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Provider Name | PETER H. NASSER DDS
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Gender | Male
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Dates
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Enumeration Date | 06/22/2009
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Last Update Date | 06/22/2009
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Provider Practice Location Address
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Address Line | 9091 ELLERBE RD SUITE 500
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City | SHREVEPORT
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State | LA
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Zip | 71106-6738
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Country | US
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Telephone | 318-864-2860
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Fax | 318-864-2863
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Provider Business Mailing Address
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Address Line | 9091 ELLERBE RD SUITE 500
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City | SHREVEPORT
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State | LA
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Zip | 71106-6738
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Country | US
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Telephone | 318-864-2860
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Fax | 318-864-2863
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 3917
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License Number State | LA
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