Individual
KORTLAN NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1413 S 2ND ST, MONROE, LA 71202-2739
(318) 323-3162
Mailing address
3814 BAYSIDE CIR, MONROE, LA 71201-2152
(318) 503-1019
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6619
LA
Other
Enumeration date
02/17/2016
Last updated
02/17/2016
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