Provider Demographics
NPI:1902475072
Name:SR MINDEN LLC
Entity type:Organization
Organization Name:SR MINDEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-294-2241
Mailing Address - Street 1:600 CLINE ST
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:LA
Mailing Address - Zip Code:71055-3010
Mailing Address - Country:US
Mailing Address - Phone:318-377-0763
Mailing Address - Fax:318-377-0764
Practice Address - Street 1:600 CLINE ST
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-3010
Practice Address - Country:US
Practice Address - Phone:318-377-0763
Practice Address - Fax:318-377-0764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty