Organization
MISS-LOU DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES VICTOR IVERSTINE DDS (OWNER)
(318) 757-4561
Entity
Organization
Contact information
Practice address
110 HIGHWAY 61 SOUTH, NATCHEZ, MS 39120
(318) 757-4561
(318) 757-4595
Mailing address
207 SERIO BLVD, FERRIDAY, LA 71334-2014
(318) 757-4561
(318) 757-4595
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3678-12
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1834190
—
LA
Enumeration date
09/18/2013
Last updated
09/18/2013
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