# WK ORAL AND MAXILLOFACIAL SURGERY INSTITUTE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104584515
- **Authorized official:** MARY JANE WARD (SENIOR VP FINANCE)
- **Authorized official phone:** (318) 716-4937

## Contact information

- **Practice address:** 2508 BERT KOUNS INDUSTRIAL LOOP STE 410, SHREVEPORT, LA 71118-3157
- **Practice address phone:** (318) 716-4939
- **Mailing address:** 2508 BERT KOUNS INDUSTRIAL LOOP STE 410, SHREVEPORT, LA 71118-3157
- **Mailing address phone:** (318) 716-4939

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 12/02/2021
- **Last updated:** 03/04/2026