Provider Demographics
NPI:1093374167
Name:LD-OXFORD, LLC
Entity Type:Organization
Organization Name:LD-OXFORD, LLC
Other - Org Name:LIFE DENTAL OXFORD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:DAIGNEAULT
Authorized Official - Suffix:
Authorized Official - Credentials:BA, MA
Authorized Official - Phone:256-783-9468
Mailing Address - Street 1:2608 S LAMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5243
Mailing Address - Country:US
Mailing Address - Phone:662-281-8455
Mailing Address - Fax:815-461-8253
Practice Address - Street 1:2608 S LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5243
Practice Address - Country:US
Practice Address - Phone:662-281-8455
Practice Address - Fax:815-461-8253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-11
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental