Organization
FERN AVENUE DENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL C HEILMAN (DENTIST)
(318) 797-1550
Entity
Organization
Contact information
Practice address
7600 FERN AVE, BLDG 1100, SHREVEPORT, LA 71105-5659
(318) 797-1550
Mailing address
7600 FERN AVE, BLDG 1100, SHREVEPORT, LA 71105-5659
(318) 797-1550
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3291
LA
Other
Enumeration date
06/11/2015
Last updated
06/11/2015
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