Organization
BROADMOOR FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER RIDDELL COOPER DDS (DENTIST)
(318) 865-3311
Entity
Organization
Contact information
Practice address
230 CARROLL ST, #4, SHREVEPORT, LA 71105-4248
(318) 865-3311
(318) 865-3339
Mailing address
230 CARROLL ST, #4, SHREVEPORT, LA 71105-4248
(318) 865-3311
(318) 865-3339
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5424
LA
122300000X
Dentist
5859
LA
Other
Enumeration date
04/25/2011
Last updated
04/25/2011
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