| Fern Avenue Dentistry, Llc | |
|
8535 Fern Ave # 2 Shreveport LA 71105-5656 | |
| (318) 798-3376 | |
| (318) 798-3310 |
| Full Name | Fern Avenue Dentistry, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 8535 Fern Ave # 2, Shreveport, Louisiana |
| Authorized Official Name and Position | Brian Kennedy Broadwell (DENTIST, OWNER) |
| Authorized Official Contact | 3187983376 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fern Avenue Dentistry, Llc 8535 Fern Ave # 2 Shreveport LA 71105-5656 Ph: (318) 798-3376 | Fern Avenue Dentistry, Llc 8535 Fern Ave # 2 Shreveport LA 71105-5656 Ph: (318) 798-3376 |
| NPI Number | 1447469069 |
|---|---|
| Provider Enumeration Date | 05/21/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447469069 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 5313 (Louisiana) | Primary |
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