Individual
SRIVARSHA PONNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2285 BENTON RD STE C100, BOSSIER CITY, LA 71111-3465
(318) 742-9333
Mailing address
2285 BENTON RD STE C100, BOSSIER CITY, LA 71111-3465
(318) 742-9333
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
7352
LA
Other
Enumeration date
07/09/2019
Last updated
11/29/2022
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