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General NPI Number Information
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NPI Number | 1952119372
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Entity Type | Organization
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Legal Business Name | 318 PEDIATRIC DENTISTRY LLC
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Dates
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Enumeration Date | 12/19/2024
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 613 KINGSTON RD
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City | BENTON
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State | LA
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Zip | 71006-3420
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Country | US
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Telephone | 318-935-9661
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Fax | 318-935-9662
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Provider Business Mailing Address
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Address Line | 613 KINGSTON RD
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City | BENTON
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State | LA
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Zip | 71006-3420
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Country | US
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Telephone | 318-935-9661
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Fax | 318-935-9662
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Authorized Official
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Title or Position | PATIENT CARE COORDINATOR
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Name | ERIN CURREN
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Credential |
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Telephone | 318-935-9661
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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 |
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License Number State |
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