Organization

Red River Dental Llc

Dental Clinic/Center in Alexandria, LA(View on Map)

Legal Business Name

Red River Dental Llc

NPI Number

1154661064

NPI Type

Organization

Enumeration Date

03/01/2013

Specialties

(Taxonomies)

Code

261QD0000X

Primary Taxonomy

Yes

Licenses

State

Louisiana

License Number

5978

Contact
Information

Purpose

Mailing
Location

Address

1408 PETERMAN DR
1408 PETERMAN DR

City

Alexandria
Alexandria

State

LA
LA

Postal Code

71301-3432
71301-3432

Country

US
US

Telephone Number

(318) 427-9220
(318) 427-9220

Authorized Official

Name

Dr. William Puckett

Title or Position

MEMBER/MANAGER

Telephone Number

(318) 427-9220

Identifiers

Identifier

1859788

Identifier State

LA

Identifier Issuer

Unknown

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 03/01/2013

Provider Address

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