Provider Demographics
NPI:1568822237
Name:RIVER CITIES DENTAL SLEEP MEDICINE CORPORATION
Entity Type:Organization
Organization Name:RIVER CITIES DENTAL SLEEP MEDICINE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:I
Authorized Official - Last Name:DUPREE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:318-797-1187
Mailing Address - Street 1:1945 E 70TH ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5347
Mailing Address - Country:US
Mailing Address - Phone:318-797-1187
Mailing Address - Fax:318-797-1164
Practice Address - Street 1:1945 E 70TH ST
Practice Address - Street 2:SUITE F
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5347
Practice Address - Country:US
Practice Address - Phone:318-797-1187
Practice Address - Fax:318-797-1164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-24
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4874332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment