Organization
ROOTS PEDIATRIC DENTISTRY, LLC
Active
Other names
ADRIENNE A. REVIERE, DDS. LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MARJORIE BROUSSARD (BUSINESS MANAGER)
(337) 234-2349
Entity
Organization
Contact information
Practice address
185 S BEADLE RD BLDG 1, LAFAYETTE, LA 70508-4287
(337) 234-2349
(337) 261-1785
Mailing address
185 S BEADLE RD BLDG 1, LAFAYETTE, LA 70508-4287
(337) 234-2349
(337) 261-1785
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1865699
—
LA
05
—
2870858
—
LA
01
—
6569
DENTIST
LA
01
—
7085
DENTIST
LA
Enumeration date
12/09/2021
Last updated
04/23/2024
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