Facts
- Status
- A
- Credential
- D.D.S.
- Type
- Individual
- Enumeration date
- 2006-01-12
- Last updated
- 2024-05-22
Specialties
Licenses
- License LA
- 4961
Location
- Practice location
- 5016 HIGHWAY 28 E
- City
- PINEVILLE LA
- Postal code
- 713604737
- Phone
- 318-448-4540
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.