NPI Number: 1972056638
Health Care Provider/Practitioner: ROSS H. DIES, J. CODY COWEN, DDS, BENJAMIN A. BEACH, DDS AND BRYAN STE
Information about “1972056638” NPI (ROSS H. DIES, J. CODY COWEN, DDS, BENJAMIN A. BEACH, DDS AND BRYAN STE)
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<?xml version="1.0" encoding="UTF-8"?>
<Npi>
<NPI>
1972056638
</NPI>
<EntityType>
Organization
</EntityType>
<ReplacementNPI/>
<EIN/>
<IsSoleProprietor/>
<IsOrgSubpart>
N
</IsOrgSubpart>
<ParentOrgLBN/>
<ParentOrgTIN/>
<OrgName>
ROSS H. DIES, J. CODY COWEN, DDS, BENJAMIN A. BEACH, DDS AND BRYAN STE
</OrgName>
<LastName/>
<FirstName/>
<MiddleName/>
<NamePrefix/>
<NameSuffix/>
<Credential/>
<OtherOrgName/>
<OtherOrgNameTypeCode>
6
</OtherOrgNameTypeCode>
<OtherLastName/>
<OtherFirstName/>
<OtherMiddleName/>
<OtherNamePrefix/>
<OtherNameSuffix/>
<OtherCredential/>
<OtherLastNameTypeCode/>
<FirstLineMailingAddress>
3412 BARKSDALE BLVD
</FirstLineMailingAddress>
<SecondLineMailingAddress>
100
</SecondLineMailingAddress>
<MailingAddressCityName>
BOSSIER CITY
</MailingAddressCityName>
<MailingAddressStateName>
LA
</MailingAddressStateName>
<MailingAddressPostalCode>
71112-3800
</MailingAddressPostalCode>
<MailingAddressCountryCode>
US
</MailingAddressCountryCode>
<MailingAddressTelephoneNumber>
318-686-7470
</MailingAddressTelephoneNumber>
<MailingAddressFaxNumber>
318-686-4505
</MailingAddressFaxNumber>
<FirstLinePracticeLocationAddress>
3412 BARKSDALE BLVD
</FirstLinePracticeLocationAddress>
<SecondLinePracticeLocationAddress>
100
</SecondLinePracticeLocationAddress>
<PracticeLocationAddressCityName>
BOSSIER CITY
</PracticeLocationAddressCityName>
<PracticeLocationAddressStateName>
LA
</PracticeLocationAddressStateName>
<PracticeLocationAddressPostalCode>
71112-3800
</PracticeLocationAddressPostalCode>
<PracticeLocationAddressCountryCode>
US
</PracticeLocationAddressCountryCode>
<PracticeLocationAddressTelephoneNumber>
318-686-7470
</PracticeLocationAddressTelephoneNumber>
<PracticeLocationAddressFaxNumber>
318-686-4505
</PracticeLocationAddressFaxNumber>
<EnumerationDate>
07/29/2016
</EnumerationDate>
<LastUpdateDate>
07/29/2016
</LastUpdateDate>
<NPIDeactivationReasonCode/>
<NPIDeactivationReason/>
<NPIDeactivationDate/>
<NPIReactivationDate/>
<GenderCode/>
<Gender/>
<AuthorizedOfficialLastName>
DIES
</AuthorizedOfficialLastName>
<AuthorizedOfficialFirstName>
ROSS
</AuthorizedOfficialFirstName>
<AuthorizedOfficialMiddleName/>
<AuthorizedOfficialTitle>
OWNER
</AuthorizedOfficialTitle>
<AuthorizedOfficialNamePrefix>
DR.
</AuthorizedOfficialNamePrefix>
<AuthorizedOfficialNameSuffix/>
<AuthorizedOfficialCredential>
DDS
</AuthorizedOfficialCredential>
<AuthorizedOfficialTelephoneNumber>
318-213-4686
</AuthorizedOfficialTelephoneNumber>
<Taxonomies>
<Taxonomy>
<TaxonomyCode>
1223P0221X
</TaxonomyCode>
<TaxonomyName>
Pediatric Dentistry
</TaxonomyName>
<LicenseNumber>
4273
</LicenseNumber>
<LicenseNumberStateCode>
LA
</LicenseNumberStateCode>
<PrimaryTaxonomySwitch>
Y
</PrimaryTaxonomySwitch>
</Taxonomy>
</Taxonomies>
<HealthcareProviderTaxonomyGroups>
<HealthcareProviderTaxonomyGroup>
<HealthcareProviderTaxonomyGroupName>
193200000X MULTI-SPECIALTY GROUP
</HealthcareProviderTaxonomyGroupName>
<HealthcareProviderTaxonomyGroupDescription>
Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization.
</HealthcareProviderTaxonomyGroupDescription>
</HealthcareProviderTaxonomyGroup>
</HealthcareProviderTaxonomyGroups>
</Npi>
<?xml version="1.0" encoding="UTF-8"?>
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