Provider Demographics
NPI:1922235597
Name:NASSER, PETER H (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:H
Last Name:NASSER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9091 ELLERBE RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-6738
Mailing Address - Country:US
Mailing Address - Phone:318-864-2860
Mailing Address - Fax:318-864-2863
Practice Address - Street 1:9091 ELLERBE RD
Practice Address - Street 2:SUITE 500
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-6738
Practice Address - Country:US
Practice Address - Phone:318-864-2860
Practice Address - Fax:318-864-2863
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA39171223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics