MEDICARE: APPLE DENTAL, L.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1447307145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APPLE DENTAL, L.L.C.

Provider Business Mailing Address
First Line	:	3301 STERLINGTON RD
Second Line	:	HWY 165 NORTH
City	:	MONROE
State	:	LA
Zip	:	71203-2521
Country	:	US
Telephone Number	:	318-325-3254
Fax Number	:

Provider Business Practice Location Address
First Line	:	3301 STERLINGTON RD
Second Line	:	HWY 165 NORTH
City	:	MONROE
State	:	LA
Zip	:	71203-2521
Country	:	US
Telephone Number	:	318-325-3254
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KEVIN P HAYNES
Credential	:	DDS
Telephone Number	:	318-325-3254

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	08/22/2020

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