Provider Demographics
NPI:1295380418
Name:W. J. DUDLEY DENTURE CONSULTANTS
Entity Type:Organization
Organization Name:W. J. DUDLEY DENTURE CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEPER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERINN
Authorized Official - Middle Name:PUMPHREY
Authorized Official - Last Name:DUDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-422-0397
Mailing Address - Street 1:4354 PINES RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71119-7738
Mailing Address - Country:US
Mailing Address - Phone:318-635-1970
Mailing Address - Fax:318-635-1972
Practice Address - Street 1:4354 PINES RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71119-7738
Practice Address - Country:US
Practice Address - Phone:318-635-1970
Practice Address - Fax:318-635-1972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental