SPD LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

SPD LLC

Doing business as

Southern Pines Dental

Practice address

1416 Hazel St
Arcadia, LA 71001-4114

Phone

(318) 855-1426

Fax

(318) 579-5038

NPI assigned

Jan 3, 2022

Organization subpart

No

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

Authorized official

Name

Dr. Kyle Gresham, DDSNPI 1134793680

Title

Member

Phone

(318) 855-1426

Specialties & licenses 1

Addresses

Other names 1

• Southern Pines Dental Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kyle Gresham, DDS

  • General Practice Dentistry
  • Arcadia, LA
  • NPI 1134793680
  NPD Authorized official

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

{
    "created_epoch": "1641168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641168000000",
    "number": "1528729555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1416 HAZEL ST",
            "city": "ARCADIA",
            "state": "LA",
            "postal_code": "710014114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1416 HAZEL ST",
            "city": "ARCADIA",
            "state": "LA",
            "postal_code": "710014114",
            "telephone_number": "318-855-1426",
            "fax_number": "318-579-5038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-03",
        "last_updated": "2022-01-03",
        "certification_date": "2022-01-03",
        "status": "A",
        "authorized_official_last_name": "GRESHAM",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "318-855-1426",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Pines Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bobbye Diane Senn
• Elizabeth Harris Smith, LPC
• Matthew Smith
• Sarah Smith
• Southern Pines Dental, LLC
• Uniqua S Stevenson
• Superior Supported Care Services LLC
• Superior Supported Care Services LLC
• Maegan Griggs Sylvester, PHD
• Philip Tanner

• Dental Clinic/Center in Arcadia, LA
• Providers in Arcadia, LA by specialty
• Dental Clinic/Center in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2022; 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.