Organization
SR BENTON LLC
Active
Other names
Southern Roots Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD MOORE DDS (OWNER)
(318) 422-6900
Entity
Organization
Contact information
Practice address
5606 BENTON RD STE A, BENTON, LA 71006-3408
(318) 741-5665
Mailing address
734 N ASHLEY RIDGE LOOP, SHREVEPORT, LA 71106-7209
(318) 294-2241
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
04/30/2024
Last updated
05/01/2024
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