Provider Demographics
NPI:1558723312
Name:A G FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:A G FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANIL
Authorized Official - Middle Name:K
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-442-4430
Mailing Address - Street 1:4017 PARLIAMENT DR ST B
Mailing Address - Street 2:
Mailing Address - City:ALEXANDIRA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3018
Mailing Address - Country:US
Mailing Address - Phone:318-442-4430
Mailing Address - Fax:318-442-7705
Practice Address - Street 1:4017 PARLIAMENT DR ST B
Practice Address - Street 2:
Practice Address - City:ALEXANDIRA
Practice Address - State:LA
Practice Address - Zip Code:71303-3018
Practice Address - Country:US
Practice Address - Phone:318-442-4430
Practice Address - Fax:318-442-7705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6354122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty