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CUDDLE KIDS DENTAL CARE OF SHREVEPORT, LLC

Pediatric Dentistry

Shreveport, Louisiana

Provider NPI: 1770028946

Organization Information:
Organization Name:  CUDDLE KIDS DENTAL CARE OF SHREVEPORT, LLC
Organization is not Subpart
Authorized Official:  CHRISHELLE WILLIAMS HEMPHILL  PEDIATRIC DENTIST/OWNER  318-5640595

Practice Location:
2433 E 70TH ST SUITE A SHREVEPORT, LA 71105 US
Tel: 318-564-0595  Fax: --

Business Mailing Address:
2433 E 70TH ST SUITE A SHREVEPORT, LA 71105 US
Tel: 318-564-0595  Fax: --

Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y1223P0221XDental Providers
Dentist
Pediatric Dentistry
LA6416

Other Provider Identifiers:

IssuerNumberStateType
1659523348LA05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin



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