Organization
RED RIVER DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM ALAN PUCKETT DDS (MEMBER/MANAGER)
(318) 427-9220
Entity
Organization
Contact information
Practice address
1408 PETERMAN DR, ALEXANDRIA, LA 71301-3432
(318) 427-9220
Mailing address
1408 PETERMAN DR, ALEXANDRIA, LA 71301-3432
(318) 427-9220
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
5978
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1859788
—
LA
Enumeration date
03/01/2013
Last updated
03/01/2013
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