Provider Demographics
NPI:1447360524
Name:ROSS H DIES DDS AND J CODY COWEN DDS A DENTAL LLC
Entity type:Organization
Organization Name:ROSS H DIES DDS AND J CODY COWEN DDS A DENTAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:DIES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:318-686-7470
Mailing Address - Street 1:910 BERT KOUNS INDUSTRIAL LOOP
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118
Mailing Address - Country:US
Mailing Address - Phone:318-686-7470
Mailing Address - Fax:318-686-4505
Practice Address - Street 1:910 BERT KOUNS INDUSTRIAL LOOP
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118
Practice Address - Country:US
Practice Address - Phone:318-686-7470
Practice Address - Fax:318-686-4505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center