Organization
DR. MICHAEL GAMBILL AND DR. DAVID GLASS LLC
Active
Other names
Pediatric Dentistry of Shreveport-Bossier
Organization subpart
No
Provider details
NPI number
Authorized official
CAROL A LLOYD (OFFICE MANAGER)
(318) 742-9333
Entity
Organization
Contact information
Practice address
2285 BENTON RD, SUITE C-100, BOSSIER CITY, LA 71111-7933
(318) 742-9333
(318) 742-1512
Mailing address
2285 BENTON RD, SUITE C-100, BOSSIER CITY, LA 71111-7933
(318) 742-9333
(318) 742-1512
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
2217
LA
1223P0221X
Pediatric Dentistry
6224
LA
1223P0221X
Pediatric Dentistry
Primary
6422
LA
1223P0221X
Pediatric Dentistry
6485
LA
1223P0221X
Pediatric Dentistry
6532
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1822175
—
LA
05
—
1864226
—
LA
05
—
1864854
—
LA
Enumeration date
05/13/2015
Last updated
05/13/2015
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