Provider Demographics
NPI:1770028946
Name:CUDDLE KIDS DENTAL CARE OF SHREVEPORT, LLC
Entity Type:Organization
Organization Name:CUDDLE KIDS DENTAL CARE OF SHREVEPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISHELLE
Authorized Official - Middle Name:WILLIAMS
Authorized Official - Last Name:HEMPHILL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MBA
Authorized Official - Phone:318-564-0595
Mailing Address - Street 1:2433 E 70TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-4787
Mailing Address - Country:US
Mailing Address - Phone:318-564-0595
Mailing Address - Fax:
Practice Address - Street 1:2433 E 70TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-4787
Practice Address - Country:US
Practice Address - Phone:318-564-0595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-27
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA64161223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1659523348Medicaid