Individual
DR. BENJAMIN MARK KACOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
3100 WOODLAWN AVE, SUITE C, SHREVEPORT, LA 71104-4637
(318) 868-8276
(318) 868-8212
Mailing address
3100 WOODLAWN AVE, SUITE C, SHREVEPORT, LA 71104-4637
(318) 868-8276
(318) 868-8212
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6201
LA
Other
Enumeration date
07/06/2011
Last updated
07/06/2011
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