Provider Demographics
NPI:1487166450
Name:EMILE T. GENEUX IIDDS, BENJAMIN A. BEACH DDS, AND ROSS H. DIES DDS, LL
Entity type:Organization
Organization Name:EMILE T. GENEUX IIDDS, BENJAMIN A. BEACH DDS, AND ROSS H. DIES DDS, LL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TEAM LEADER
Authorized Official - Prefix:
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-688-1040
Mailing Address - Street 1:2533 BERT KOUN LOOP STE 107
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3158
Mailing Address - Country:US
Mailing Address - Phone:318-688-1040
Mailing Address - Fax:318-688-3039
Practice Address - Street 1:2533 BERT KOUN LOOP STE 107
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3158
Practice Address - Country:US
Practice Address - Phone:318-688-1040
Practice Address - Fax:318-688-3039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-31
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty