Provider Demographics
NPI:1659511624
Name:TED A. METHVIN DDS, A DENTAL CORPORATION
Entity Type:Organization
Organization Name:TED A. METHVIN DDS, A DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TED
Authorized Official - Middle Name:A
Authorized Official - Last Name:METHVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:318-238-3335
Mailing Address - Street 1:116 SOUTH DR
Mailing Address - Street 2:STE. 102
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-5067
Mailing Address - Country:US
Mailing Address - Phone:318-238-3335
Mailing Address - Fax:318-238-3339
Practice Address - Street 1:116 SOUTH DR
Practice Address - Street 2:STE. 102
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-5067
Practice Address - Country:US
Practice Address - Phone:318-238-3335
Practice Address - Fax:318-238-3339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA59421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty