Provider Demographics
NPI:1316145782
Name:REDDIX DENTAL CLINIC, INC.
Entity type:Organization
Organization Name:REDDIX DENTAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OLLIBETH
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-322-6360
Mailing Address - Street 1:1201 POWELL ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-5342
Mailing Address - Country:US
Mailing Address - Phone:318-322-6360
Mailing Address - Fax:318-361-3788
Practice Address - Street 1:1201 POWELL ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-5342
Practice Address - Country:US
Practice Address - Phone:318-322-6360
Practice Address - Fax:318-361-3788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA34961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty