Organization
IVY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDRETTA RRENEE PORTER-WILLIAMS DDS (OWNER)
(318) 868-4188
Entity
Organization
Contact information
Practice address
460 ASHLEY RIDGE BLVD STE 600, SHREVEPORT, LA 71106-7238
(318) 868-4188
(318) 868-9151
Mailing address
460 ASHLEY RIDGE BLVD STE 600, SHREVEPORT, LA 71106-7238
(318) 868-4188
(318) 868-9151
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4645
LA
Other
Enumeration date
08/25/2011
Last updated
08/25/2011
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