Provider Demographics
NPI:1992390793
Name:ALEXANDRIA SMILE CENTER LLC
Entity Type:Organization
Organization Name:ALEXANDRIA SMILE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MOYLAN
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:318-545-7606
Mailing Address - Street 1:3511 PARLIAMENT CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3135
Mailing Address - Country:US
Mailing Address - Phone:318-545-7606
Mailing Address - Fax:318-545-7626
Practice Address - Street 1:3511 PARLIAMENT CT
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3135
Practice Address - Country:US
Practice Address - Phone:318-545-7606
Practice Address - Fax:318-545-7626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-03
Last Update Date:2021-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental