Sr Bossier LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

SR BOSSIER LLC

Doing business as

Southern Roots Dentistry

Practice address

2369 Airline Dr Ste 330
Bossier City, LA 71111-5867

Phone

(318) 658-9622

Fax

(318) 658-9628

NPI assigned

Jul 12, 2022

Organization subpart

No

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

Authorized official

Name

Abigail Renee Howell

Title

Practice Management

Phone

(318) 294-2241

Specialties & licenses 1

Addresses

Other names 1

• Southern Roots Dentistry 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.

• Jeremy D Brown, DDS

  • General Practice Dentistry
  • Bossier City, LA
  • NPI 1265797450
  NPD (past)

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

{
    "created_epoch": "1657584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657584000000",
    "number": "1821722240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2369 AIRLINE DR STE 330",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711115867",
            "telephone_number": "318-658-9622",
            "fax_number": "318-658-9628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2369 AIRLINE DR STE 330",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711115867",
            "telephone_number": "318-658-9622",
            "fax_number": "318-658-9628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SR BOSSIER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-12",
        "last_updated": "2022-07-12",
        "certification_date": "2022-07-12",
        "status": "A",
        "authorized_official_last_name": "HOWELL",
        "authorized_official_first_name": "ABIGAIL",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "PRACTICE MANAGEMENT",
        "authorized_official_telephone_number": "318-294-2241"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Roots Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Bossier City, LA
• Providers in Bossier City, LA by specialty
• General Practice Dentistry in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 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.