Organization
SOUTHERN MAGNOLIA DENTISTRY, LLC
Active
Other names
Southern Magnolia Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
AKEELE JOHNSON-VALLOT (OWNER)
(318) 229-3121
Entity
Organization
Contact information
Practice address
3215 MASONIC DR, ALEXANDRIA, LA 71301-4246
(318) 229-3121
Mailing address
3215 MASONIC DR, ALEXANDRIA, LA 71301-4246
(318) 229-3121
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
09/29/2023
Last updated
10/02/2023
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