| NPI | 1215261532 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN D WARD Owner 318-387-6222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: LA 5379) |
| Additional Taxonomies | 122300000X Dentist (Licence: LA 5975) |
| Enumeration Date | 2009-09-21 |
| Last Update Date | 2009-09-21 |