| NPI | 1528359536 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER RIDDELL COOPER Dentist 318-865-3311 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: LA 5424) |
| Additional Taxonomies | 122300000X Dentist (Licence: LA 5859) |
| Enumeration Date | 2011-04-25 |
| Last Update Date | 2011-04-25 |