Provider Demographics
NPI:1609223833
Name:HORSESHOE DENTAL LLC
Entity Type:Organization
Organization Name:HORSESHOE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:EDDY
Authorized Official - Middle Name:WALLER
Authorized Official - Last Name:SHERMAN
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:318-228-9911
Mailing Address - Street 1:164 COUNTRY CLUB CIRCLE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MINDEN
Mailing Address - State:LA
Mailing Address - Zip Code:71055-7502
Mailing Address - Country:US
Mailing Address - Phone:318-639-9559
Mailing Address - Fax:318-639-9560
Practice Address - Street 1:164 COUNTRY CLUB CIRCLE
Practice Address - Street 2:SUITE A
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-7502
Practice Address - Country:US
Practice Address - Phone:318-639-9559
Practice Address - Fax:318-639-9560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5738122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5738OtherDENTIST