| NPI | 1942715917 |
|---|---|
| Doing Business As | SOUTHERN ROOTS DENTAL OF LOUISIANA |
| Entity Type | Organization |
| Authorized Contact | JULIE LEBELL SIMPSON Owner Dentist 318-605-2015 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2017-12-12 |
| Last Update Date | 2017-12-12 |