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Organization

TRAVELING LIGHT DENTAL LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. BENJAMIN MARK KACOS D.M.D. (DENTIST)
(318) 869-2593
Entity
Organization

Contact information

Practice address
230 CARROLL ST, SUITE 3, SHREVEPORT, LA 71105
(318) 869-2593
(318) 869-2592
Mailing address
230 CARROLL ST, SUITE 3, SHREVEPORT, LA 71105
(318) 869-2593
(318) 869-2592

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary

Other

Enumeration date
06/11/2021
Last updated
06/11/2021
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