ARKLATEX ORAL & MAXILLOFACIAL SURGERY A PARTNERSHIP OF PROFESSIONAL DE (NPI# 1003092545) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003092545 |
| Entity Type | Organization |
| Organization Name | ARKLATEX ORAL & MAXILLOFACIAL SURGERY A PARTNERSHIP OF PROFESSIONAL DE |
| Practice Address |
7600 Fern Ave Building 1400 Shreveport LA 71105-5659 |
| Practice Telephone | 3187975812 |
| Mailing Telephone | 3187975812 |
| Enumeration Date | 2008-01-15 |
| Last Update Date | 2011-02-02 |
| Authorized Official Name | BRIAN R SMITH (PRESIDENT) |
| Authorized Official Telephone | 3187975812 |
| Authorized Official Credential | DDS, MS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
Dental Providers |
| Street Address |
7600 FERN AVE BUILDING 1400 |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71105-5659 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750347498 | Jason Harold Lustig | Dentist | 7600 Fern Ave, Building 1400, Shreveport, LA 71105-5659 | 2006-04-21 |
| 1114308582 | Fern Avenue Dental Center | Dentist | 7600 Fern Ave, Bldg 1100, Shreveport, LA 71105-5659 | 2015-06-11 |
| 1497875553 | Paul Collins Heilman | Dentist | 7600 Fern Ave, Bldg #1100, Shreveport, LA 71105-5659 | 2007-03-30 |
| 1275680852 | Holly C Cook | Dentist | 7600 Fern Ave, Building 800, Shreveport, LA 71105-5659 | 2007-01-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699245928 | Misty Johnetta Ross | Counselor | 2942 Knight St., Bldg. 4 Suite 426, Shreveport, LA 71105 | 2018-11-29 |
| 1205301868 | Tatjhana Maury | Case Manager/Care Coordinator | 3325 Youree Drive, Shreveport, LA 71105 | 2018-10-10 |
| 1245710920 | Jefferey Douglas Adair Md | Non-Pharmacy Dispensing Site | 8860 Fern Ave., Suite 120, Shreveport, LA 71105 | 2018-08-21 |
| 1679059539 | Michael E Woolbert Dds LLC | Dentist | 7600 Fern Avenue, Building 1100, Shreveport, LA 71105 | 2018-07-13 |
| 1881195675 | Adiba Bibi | Pharmacist | 3555 Greenwood Road, Walgreens, Shreveport, LA 71105 | 2018-02-27 |
| 1740796655 | Allison Borel | Counselor | 2020 E 70th St Ste 201, Shreveport, LA 71105 | 2017-12-15 |
| 1073028148 | Valerie Wooten Barcelona | Physical Therapist | 130 Kayla Street, Shreveport, LA 71105 | 2017-12-11 |
| 1710497615 | Jimmy Carroll | Counselor | 2960 Knight St, Suite 110, Shreveport, LA 71105 | 2017-10-05 |
| 1932618444 | David Louis Bennett | Counselor | 3007 Knight St., Suite 200, Shreveport, LA 71105 | 2017-09-27 |
| 1619496452 | Shaqwana Hodge | Counselor | 2920 Knight St. Suite 110, Shreveport, LA 71105 | 2017-09-13 |
| Find all providers in zip 71105 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588078224 | Ricardo Lugo | Dentist | 1501 Kings Hwy Rm 530, Shreveport, LA 71103-4228 | 2014-06-19 |
| 1548427693 | David Kyle Clark | Dentist | 2120 Bert Kouns Loop Ste D, Shreveport, LA 71118-3351 | 2008-05-16 |
| 1801931209 | Walter Joseph James | Dentist | 915 Shreveport Barksdale Hwy, Shreveport, LA 71105-2205 | 2007-02-21 |
| 1194731836 | James William Sikes Jr. | Dentist | 6912 Fern Loop Ste A, Shreveport, LA 71105-4176 | 2006-08-01 |
| 1639191182 | Brian Roy Smith | Dentist | 2125 E Bert Kouns Industrial Loop, Shreveport, LA 71105-5314 | 2006-07-24 |
| 1750347498 | Jason Harold Lustig | Dentist | 7600 Fern Ave, Building 1400, Shreveport, LA 71105-5659 | 2006-04-21 |
| 1285806810 | Wendell Wayne Neeley II | Dentist | 1501 Kings Hwy, Shreveport, LA 71103-4228 | 2008-03-24 |
| 1104095520 | Celso Fernando Palmieri | Dentist | 1501 Kings Hwy, Department of Oral Surgery, Shreveport, LA 71103-4228 | 2008-02-29 |
| 1326188145 | William Brantley Goyne | Dentist | 2001 E 70th St, Suite 606, Shreveport, LA 71105-5328 | 2007-02-08 |
| 1821016957 | Dongsoo David Kim | Dentist | 1501 Kings Hwy, Department of Oral Surgery, Shreveport, LA 71103-4228 | 2006-07-17 |
| Find all providers in SHREVEPORT | ||||
| City | SHREVEPORT |
| Zip Code | 71105 |
Please comment or provide details below to improve the information on ARKLATEX ORAL & MAXILLOFACIAL SURGERY A PARTNERSHIP OF PROFESSIONAL DE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.