| Southern Roots Dentistry | |
|
5606 Benton Rd Ste A Benton LA 71006-3408 | |
| (318) 741-5665 | |
| Not Available |
| Full Name | Southern Roots Dentistry |
|---|---|
| Speciality | Dentist |
| Location | 5606 Benton Rd Ste A, Benton, Louisiana |
| Authorized Official Name and Position | Richard Moore (OWNER) |
| Authorized Official Contact | 3184226900 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Roots Dentistry 734 N Ashley Ridge Loop Shreveport LA 71106-7209 Ph: (318) 294-2241 | Southern Roots Dentistry 5606 Benton Rd Ste A Benton LA 71006-3408 Ph: (318) 741-5665 |
| NPI Number | 1417703398 |
|---|---|
| Provider Enumeration Date | 04/30/2024 |
| Last Update Date | 05/01/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417703398 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
Benton Family Dentistry Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 192 Burt Blvd, Benton, LA 71006 Phone: 318-965-2424 Fax: 318-965-0943 |