| NPI | 1154859320 |
|---|---|
| Doing Business As | SOUTHERN ROOTS DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | JAMES LOWDER Owner Dr 318-701-8885 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 6747) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 6750) |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2018-07-23 |