Individual
DR. DEEPASULOCHANA SIVASANKARAGANESAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.M.D
Contact information
Practice address
3719 JEWELLA AVE, SHREVEPORT, LA 71109
(318) 550-3362
Mailing address
3719 JEWELLA AVE, SHREVEPORT, LA 71109-4703
(330) 840-9341
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DN1857088
MA
1223G0001X
General Practice Dentistry
Primary
6936
LA
Other
Enumeration date
09/30/2015
Last updated
12/26/2018
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