Organization
SR MANSFIELD LLC
Active
Other names
Southern Roots Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
ABIGAIL HOWELL (PRACTICE MANAGER)
(318) 294-2241
Entity
Organization
Contact information
Practice address
126 JEFFERSON ST, MANSFIELD, LA 71052-2600
(318) 872-1557
Mailing address
126 JEFFERSON ST, MANSFIELD, LA 71052-2600
(318) 872-1557
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
Other
Enumeration date
08/31/2021
Last updated
08/31/2021
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