Individual
DR. FRED G REW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1140 POLK STREET, SUITE #A, MANSFIELD, LA 71052
(318) 872-3972
(318) 872-3976
Mailing address
PO BOX 1019, 1140 POLK STREET SUITE #A, MANSFIELD, LA 71052
(318) 872-3972
(318) 872-3976
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3194
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1831948
—
LA
Enumeration date
04/13/2007
Last updated
07/08/2007
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