ROOTS PEDIATRIC DENTISTRY LLC NPI 1467111203

NPI Information

ROOTS PEDIATRIC DENTISTRY, LLC is a dental clinic center in Lafayette, LA. ROOTS PEDIATRIC DENTISTRY, LLC NPI is 1467111203. The provider is registered as an organization entity type.
The provider Former Legal Business Name Is Adrienne A. Reviere, Dds. Llc.

The provider's business location address is:

185 S BEADLE RD BLDG 1
LAFAYETTE, LA
ZIP 70508-287
Phone: (337) 234-2349
Fax: (337) 261-1785

The provider's authorized official is Marjorie Broussard .
The authorized official title is Business Manager and has the following contact phone number (337) 234-2349.

The enumeration date for this NPI number is 12/9/2021 and was last updated on 4/23/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

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