| Wk Oral And Maxillofacial Surgery Institute | |
|
2508 Bert Kouns Industrial Loop Ste 410 Shreveport LA 71118-3157 | |
| (318) 716-4939 | |
| Not Available |
| Full Name | Wk Oral And Maxillofacial Surgery Institute |
|---|---|
| Speciality | Dentist |
| Location | 2508 Bert Kouns Industrial Loop Ste 410, Shreveport, Louisiana |
| Authorized Official Name and Position | Mary Jane Ward (SENIOR VP FINANCE) |
| Authorized Official Contact | 3187164937 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wk Oral And Maxillofacial Surgery Institute 2508 Bert Kouns Industrial Loop Ste 410 Shreveport LA 71118-3157 Ph: (318) 716-4939 | Wk Oral And Maxillofacial Surgery Institute 2508 Bert Kouns Industrial Loop Ste 410 Shreveport LA 71118-3157 Ph: (318) 716-4939 |
| NPI Number | 1104584515 |
|---|---|
| Provider Enumeration Date | 12/02/2021 |
| Last Update Date | 12/02/2021 |
| Medicare PECOS PAC ID | 6002203767 |
|---|---|
| Medicare Enrollment ID | O20220427001091 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104584515 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| Provider Name | Ghali E Ghali |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1417981739 PECOS PAC ID: 3971518408 Enrollment ID: I20060220000458 |
| Provider Name | Brett M Shirley |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1467624973 PECOS PAC ID: 0042436362 Enrollment ID: I20151215002575 |
| Provider Name | Ross David Brockman |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1427587054 PECOS PAC ID: 6800244898 Enrollment ID: I20231201000989 |
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