Organization
CECIL C GADDIS DDS., A PROFESSIONAL DENTAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CECIL CLYDE GADDIS DDS (PRESIDENT)
(318) 992-6175
Entity
Organization
Contact information
Practice address
2709 NORTH FIRST STREET, JENA, LA 71342
(318) 992-6175
(318) 992-6197
Mailing address
P.O. BOX 891, JENA, LA 71342
(318) 992-6175
(318) 992-6197
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1826456
—
LA
Enumeration date
03/22/2016
Last updated
03/22/2016
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