| Southern Roots Dentistry | |
|
2369 Airline Dr Ste 330 Bossier City LA 71111-5867 | |
| (318) 658-9622 | |
| (318) 658-9628 |
| Full Name | Southern Roots Dentistry |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2369 Airline Dr Ste 330, Bossier City, Louisiana |
| Authorized Official Name and Position | Abigail Renee Howell (PRACTICE MANAGEMENT) |
| Authorized Official Contact | 3182942241 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Roots Dentistry 2369 Airline Dr Ste 330 Bossier City LA 71111-5867 Ph: (318) 658-9622 | Southern Roots Dentistry 2369 Airline Dr Ste 330 Bossier City LA 71111-5867 Ph: (318) 658-9622 |
| NPI Number | 1821722240 |
|---|---|
| Provider Enumeration Date | 07/12/2022 |
| Last Update Date | 07/12/2022 |
| Certification Date | 07/12/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821722240 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | () | Primary |
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