Individual
NINTA SOUTHICHACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
230 CARROLL ST STE 3, SHREVEPORT, LA 71105-4248
(318) 693-0091
Mailing address
1400 TOPLEA DR, EULESS, TX 76040-4976
(682) 203-8530
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
40137
TX
122300000X
Dentist
Primary
7641
LA
Other
Enumeration date
02/28/2023
Last updated
02/24/2025
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