| NPI | 1316145782 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OLLIBETH REDDIX Director 318-322-6360 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 3496) |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2020-08-22 |