| Red River Dental Llc | |
|
1408 Peterman Dr Alexandria LA 71301-3432 | |
| (318) 427-9220 | |
| Not Available |
| Full Name | Red River Dental Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1408 Peterman Dr, Alexandria, Louisiana |
| Authorized Official Name and Position | William Alan Puckett (MEMBER/MANAGER) |
| Authorized Official Contact | 3184279220 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Red River Dental Llc 1408 Peterman Dr Alexandria LA 71301-3432 Ph: (318) 427-9220 | Red River Dental Llc 1408 Peterman Dr Alexandria LA 71301-3432 Ph: (318) 427-9220 |
| NPI Number | 1154661064 |
|---|---|
| Provider Enumeration Date | 03/01/2013 |
| Last Update Date | 03/01/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154661064 | NPI | - | NPPES |
| 1859788 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 5978 (Louisiana) | Primary |
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