Sr Mansfield LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

SR MANSFIELD LLC

Doing business as

Southern Roots Dentistry

Practice address

126 Jefferson St
Mansfield, LA 71052-2600

Phone

(318) 872-1557

NPI assigned

Aug 31, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Abigail Howell

Title

Practice Manager

Phone

(318) 294-2241

Specialties & licenses 2

Addresses

Other names 1

• Southern Roots Dentistry Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1630368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630368000000",
    "number": "1285302737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "126 JEFFERSON ST",
            "city": "MANSFIELD",
            "state": "LA",
            "postal_code": "710522600",
            "telephone_number": "318-872-1557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 JEFFERSON ST",
            "city": "MANSFIELD",
            "state": "LA",
            "postal_code": "710522600",
            "telephone_number": "318-872-1557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SR MANSFIELD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-31",
        "last_updated": "2021-08-31",
        "certification_date": "2021-08-31",
        "status": "A",
        "authorized_official_last_name": "HOWELL",
        "authorized_official_first_name": "ABIGAIL",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "318-294-2241"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Roots Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ashley Rael Sepulvado, FNP-C
• Anika C Simmons
• Brandon Slacks
• Bertha Sligh
• Shemaria Smith
• Steadfast Care Mobile Phlebotomy LLC
• Superior Hospice of Northwest Louisiana, LLC
• Erica Taylor
• Melisa Taylor
• Christopher Thomas

• Dentist in Mansfield, LA
• Providers in Mansfield, LA by specialty
• Dentist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.