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189 Greenbriar Blvd Suite A Covington LA 70433-7234 | |
| (504) 400-4539 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 189 Greenbriar Blvd, Covington, Louisiana |
| Authorized Official Name and Position | Stephen Cole Holmes (OWNER) |
| Authorized Official Contact | 5044004539 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
189 Greenbriar Blvd Suite A Covington LA 70433-7234 Ph: (504) 400-4539 | 189 Greenbriar Blvd Suite A Covington LA 70433-7234 Ph: (504) 400-4539 |
| NPI Number | 1356682728 |
|---|---|
| Provider Enumeration Date | 03/11/2013 |
| Last Update Date | 03/11/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356682728 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 5923 (Louisiana) | Primary |
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