Provider Demographics
NPI:1821722240
Name:SR BOSSIER LLC
Entity Type:Organization
Organization Name:SR BOSSIER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-294-2241
Mailing Address - Street 1:2369 AIRLINE DR STE 330
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-5867
Mailing Address - Country:US
Mailing Address - Phone:318-658-9622
Mailing Address - Fax:318-658-9628
Practice Address - Street 1:2369 AIRLINE DR STE 330
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-5867
Practice Address - Country:US
Practice Address - Phone:318-658-9622
Practice Address - Fax:318-658-9628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty