Peach Tree Dental West Monroe, LLC
Clinic/Center, Dental in West Monroe, LA. Organization (NPI-2).
NPI number1699314799
StatusActive
Last updated in NPPESJan 6, 2020
Details
- NPI
- 1699314799
- Entity type
- Organization (NPI-2)
- Legal business name
- Peach Tree Dental West Monroe, LLC
- Organization subpart
- No
- Enumeration date
- Jan 6, 2020
- Certification date
- Jan 6, 2020
- Last updated
- Jan 6, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | – | – | Yes |
Practice location
3422 Cypress StWest Monroe, LA 71291-7310
Phone 318-381-9340
Mailing address
3422 Cypress StWest Monroe, LA 71291-7310
Authorized official
Joni Porter
Coo
3183819340
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