Organization
SANDEFER PREMIER DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLINT NATHAN SANDEFER D.D.S (OWNER)
(225) 664-4121
Entity
Organization
Contact information
Practice address
1291 FLORIDA AVE SW, DENHAM SPRINGS, LA 70726-4635
(225) 664-4121
(225) 664-7774
Mailing address
1291 FLORIDA AVE SW, DENHAM SPRINGS, LA 70726-4635
(225) 664-4121
(225) 664-7774
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1856584
—
LA
05
—
32053
—
LA
Enumeration date
06/07/2016
Last updated
06/07/2016
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