SOUTHERN ROOTS DENTISTRY LLC (NPI# 1154859320) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154859320 |
| Entity Type | Organization |
| Organization Name | SOUTHERN ROOTS DENTISTRY LLC |
| Other Organization Name | SOUTHERN ROOTS DENTISTRY |
| Practice Address |
8691 Line Ave Ste 300 Shreveport LA 71106 |
| Mailing Address |
8691 Line Ave Ste 300 Shreveport LA 71106-6107 |
| Practice Telephone | 3187018885 |
| Mailing Telephone | 3187018885 |
| Mailing Fax Number | 3187018887 |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2018-07-23 |
| Authorized Official Name | DR. JAMES LOWDER (OWNER DR) |
| Authorized Official Telephone | 3187018885 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223G0001X |
Dentist Specialization: General Practice |
6750 | LA | Dental Providers |
| Y | 1223G0001X |
Dentist Specialization: General Practice |
6747 | LA | Dental Providers |
| Other Name | Type Code |
|---|---|
| Southern Roots Dentistry | Doing Business As Name - Organization |
| Street Address |
8691 LINE AVE STE 300 |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71106 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134656382 | James Lowder | Dentist | 8691 Line Ave Ste 300, Shreveport, LA 71106 | 2017-05-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972008332 | Andrew Joseph Brouillette | Dentist | 385 Bert Kouns Industrial Loop Ste 700, Shreveport, LA 71106 | 2018-03-28 |
| 1548775885 | David Wayne Spears | Pharmacist | 10460 Norris Ferry Road, Shreveport, LA 71106 | 2017-12-08 |
| 1225559263 | Susan Anderson Roblow | Physical Therapist | 921 Unadilla Street, Shreveport, LA 71106 | 2017-06-29 |
| 1144753708 | Laverne Brantley | Counselor | 328 E 69th St, Shreveport, LA 71106 | 2017-04-10 |
| 1437690849 | Biostat Laboratories, LLC | Clinical Medical Laboratory | 9742 Saint Vincent Ave Ste 200, Shreveport, LA 71106 | 2017-03-17 |
| 1841730728 | Cedric Thomas | Case Manager/Care Coordinator | 6811 Fairfield Avenue, Shreveport, LA 71106 | 2017-02-27 |
| 1225576192 | Nick Vergis | Pharmacist | 5828 Line Avenue, Shreveport, LA 71106 | 2017-02-10 |
| 1184162554 | Marilyn Johnson | Case Manager/Care Coordinator | 9245 Wallace Lake Rd Ste A, Shreveport, LA 71106 | 2017-02-06 |
| 1417499740 | Pamela Lee | Counselor | 8802 Coyth Ln, Shreveport, LA 71106 | 2016-11-17 |
| 1871044586 | Lester Jackson Jr. | Case Manager/Care Coordinator | 378 W. 79th St, Shreveport, LA 71106 | 2016-10-18 |
| Find all providers in zip 71106 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003385899 | Scruggs Dental LLC | Dentist | 2001 E. 70th Street, Suite 105, Shreveport, LA 71005 | 2018-11-21 |
| 1679059539 | Michael E Woolbert Dds LLC | Dentist | 7600 Fern Avenue, Building 1100, Shreveport, LA 71105 | 2018-07-13 |
| 1972008332 | Andrew Joseph Brouillette | Dentist | 385 Bert Kouns Industrial Loop Ste 700, Shreveport, LA 71106 | 2018-03-28 |
| 1003310053 | Erin O'neal | Dentist | 7030 Youree Dr Ste B, Shreveport, LA 71105-5109 | 2018-03-22 |
| 1487166450 | Emile T. Geneux IIdds, Benjamin A. Beach Dds, and Ross H. Dies Dds, Ll | Dentist | 2533 Bert Koun Loop Ste 107, Shreveport, LA 71118-3158 | 2017-10-31 |
| 1134656382 | James Lowder | Dentist | 8691 Line Ave Ste 300, Shreveport, LA 71106 | 2017-05-18 |
| 1720447147 | Dr. Monica A. Davenport, Dds Apc | Dentist | 1850 Martin Luther King Dr., Shreveport, LA 71107-5020 | 2016-02-12 |
| 1366822710 | A Brighter Smile | Dentist | 385 Bert Kouns Loop, Suite 700, Shreveport, LA 71106-8158 | 2015-06-01 |
| 1104250364 | Witte Family Dentistry, LLC | Dentist | 137 E Kings Hwy, Shreveport, LA 71104-3404 | 2013-08-23 |
| 1063792752 | Ivy Dental | Dentist | 460 Ashley Ridge Blvd Ste 600, Shreveport, LA 71106-7238 | 2011-08-25 |
| Find all providers in SHREVEPORT | ||||
| City | SHREVEPORT |
| Zip Code | 71106 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.