Organization
SR BOSSIER LLC
Active
Other names
Southern Roots Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
ABIGAIL RENEE HOWELL (PRACTICE MANAGEMENT)
(318) 294-2241
Entity
Organization
Contact information
Practice address
2369 AIRLINE DR STE 330, BOSSIER CITY, LA 71111-5867
(318) 658-9622
(318) 658-9628
Mailing address
2369 AIRLINE DR STE 330, BOSSIER CITY, LA 71111-5867
(318) 658-9622
(318) 658-9628
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
07/12/2022
Last updated
07/12/2022
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