Organization
SHREVEPORT PERIODONTAL SPECIALISTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA WATSON (COO)
(318) 868-0535
Entity
Organization
Contact information
Practice address
745 EDGEMONT ST, SHREVEPORT, LA 71106-2246
(318) 868-0535
(318) 868-0572
Mailing address
745 EDGEMONT ST, SHREVEPORT, LA 71106-2246
(318) 868-0535
(318) 868-0572
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
Other
Enumeration date
11/19/2024
Last updated
11/19/2024
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