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2281 Benton Rd Bossier City LA 71111-3403 | |
| (318) 742-9852 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 2281 Benton Rd, Bossier City, Louisiana |
| Authorized Official Name and Position | Charles P Brigham (OWNER) |
| Authorized Official Contact | 3187429852 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2281 Benton Rd Bossier City LA 71111-3403 Ph: (318) 742-9852 | 2281 Benton Rd Bossier City LA 71111-3403 Ph: (318) 742-9852 |
| NPI Number | 1023246121 |
|---|---|
| Provider Enumeration Date | 06/26/2009 |
| Last Update Date | 06/26/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023246121 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 4469 (Louisiana) | Primary |
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