| |
3215 Masonic Dr Alexandria LA 71301-4246 | |
(318) 229-3121 | |
Not Available |
Full Name | |
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Speciality | Dentist |
Location | 3215 Masonic Dr, Alexandria, Louisiana |
Authorized Official Name and Position | Akeele Johnson-vallot (OWNER) |
Authorized Official Contact | 3182293121 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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3215 Masonic Dr Alexandria LA 71301-4246 Ph: (318) 229-3121 | 3215 Masonic Dr Alexandria LA 71301-4246 Ph: (318) 229-3121 |
NPI Number | 1598545386 |
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Provider Enumeration Date | 09/29/2023 |
Last Update Date | 10/02/2023 |
Medicare PECOS PAC ID | 3678017647 |
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Medicare Enrollment ID | O20240701003610 |
Identifier | Type | State | Issuer |
---|---|---|---|
1598545386 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
Provider Name | Akeele Ayanna Johnson-vallot |
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Provider Type | Practitioner - Pediatric Dentistry |
Provider Identifiers | NPI Number: 1144574450 PECOS PAC ID: 5294134110 Enrollment ID: I20240701003737 |
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