| NPI | 1417703398 |
|---|---|
| Doing Business As | SOUTHERN ROOTS DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | RICHARD MOORE Owner 318-422-6900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2024-04-30 |
| Last Update Date | 2024-05-01 |