Provider Demographics
NPI:1528615887
Name:BENJAMIN A. BEACH DDS AND ROSS H. DIES DDS MIDCITY, LLC
Entity type:Organization
Organization Name:BENJAMIN A. BEACH DDS AND ROSS H. DIES DDS MIDCITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:COPE
Authorized Official - Suffix:
Authorized Official - Credentials:RHD
Authorized Official - Phone:318-213-4686
Mailing Address - Street 1:8510 LINE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-6119
Mailing Address - Country:US
Mailing Address - Phone:318-686-7470
Mailing Address - Fax:
Practice Address - Street 1:8510 LINE AVE STE A
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-6119
Practice Address - Country:US
Practice Address - Phone:318-686-7470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental