| Southern Pines Dental, Llc | |
|
1416 Hazel St Arcadia LA 71001-4114 | |
| (318) 855-1426 | |
| (318) 579-5038 |
| Full Name | Southern Pines Dental, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1416 Hazel St, Arcadia, Louisiana |
| Authorized Official Name and Position | Jesse Roberts (OWNER/DENTIST) |
| Authorized Official Contact | 3188551426 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Pines Dental, Llc 1416 Hazel St. Arcadia LA 71001 Ph: (318) 855-1426 | Southern Pines Dental, Llc 1416 Hazel St Arcadia LA 71001-4114 Ph: (318) 855-1426 |
| NPI Number | 1922457175 |
|---|---|
| Provider Enumeration Date | 06/08/2016 |
| Last Update Date | 06/08/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922457175 | NPI | - | NPPES |
| 1835862 | Medicaid | LA | |
| 32635 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 3586 (Louisiana) | Primary |
| 1223G0001X | Dentist - General Practice | 6627 (Louisiana) | Secondary |
Spd Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1416 Hazel St, Arcadia, LA 71001 Phone: 318-855-1426 Fax: 318-579-5038 |