Organization
SUPERIOR DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAKE OBRIEN DDS (PRESIDENT)
(318) 868-5726
Entity
Organization
Contact information
Practice address
6150 LINE AVE, SHREVEPORT, LA 71106-2051
(318) 868-5726
Mailing address
6150 LINE AVE, SHREVEPORT, LA 71106-2051
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
08/18/2023
Last updated
08/18/2023
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