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General NPI Number Information
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NPI Number | 1972056638
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Entity Type | Organization
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Legal Business Name | ROSS H. DIES, J. CODY COWEN, DDS, BENJAMIN A. BEACH, DDS AND BRYAN STE
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Dates
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Enumeration Date | 07/29/2016
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Last Update Date | 07/29/2016
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Provider Practice Location Address
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Address Line | 3412 BARKSDALE BLVD 100
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City | BOSSIER CITY
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State | LA
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Zip | 71112-3800
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Country | US
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Telephone | 318-686-7470
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Fax | 318-686-4505
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Provider Business Mailing Address
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Address Line | 3412 BARKSDALE BLVD 100
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City | BOSSIER CITY
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State | LA
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Zip | 71112-3800
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Country | US
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Telephone | 318-686-7470
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Fax | 318-686-4505
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROSS DIES
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Credential | DDS
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Telephone | 318-213-4686
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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 | 4273
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License Number State | LA
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