Organization
FERN AVENUE DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN KENNEDY BROADWELL DDS (DENTIST, OWNER)
(318) 798-3376
Entity
Organization
Contact information
Practice address
8535 FERN AVE # 2, SHREVEPORT, LA 71105-5656
(318) 798-3376
(318) 798-3310
Mailing address
8535 FERN AVE # 2, SHREVEPORT, LA 71105-5656
(318) 798-3376
(318) 798-3310
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5313
LA
Other
Enumeration date
05/21/2007
Last updated
08/22/2020
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