Organization
JAN T BAGWELL DDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAN T BAGWELL DDS (OWNER)
(318) 665-4423
Entity
Organization
Contact information
Practice address
189 KEYSTONE RD, MONROE, LA 71203-8936
(318) 665-4423
Mailing address
189 KEYSTONE RD, MONROE, LA 71203-8936
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1760917561
NATIONAL PROVIDER NUMBER/ NPI
LA
Enumeration date
01/10/2019
Last updated
01/10/2019
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