Provider Demographics
NPI:1942715917
Name:MONROE DENTAL GROUP LLC
Entity Type:Organization
Organization Name:MONROE DENTAL GROUP LLC
Other - Org Name:SOUTHERN ROOTS DENTAL OF LOUISIANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:LEBELL
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:318-605-2015
Mailing Address - Street 1:1503 SPENCER AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-4149
Mailing Address - Country:US
Mailing Address - Phone:318-557-6338
Mailing Address - Fax:
Practice Address - Street 1:1401 N 18TH ST STE E
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-4972
Practice Address - Country:US
Practice Address - Phone:318-605-2015
Practice Address - Fax:318-737-1239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty