# ORAL & MAXILLOFACIAL SURGERY CENTER OF SOUTH LOUISIANA LLC

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

## Provider details

- **NPI number:** 1629642046
- **Authorized official:** JOSHUA BRANDNER DDS, MD (OWNER)
- **Authorized official phone:** (985) 640-2236

## Contact information

- **Practice address:** 363 LAKEVIEW CT, COVINGTON, LA 70433-7515
- **Practice address phone:** (985) 687-1616
- **Practice address fax:** (888) 920-7457
- **Mailing address:** 363 LAKEVIEW CT, COVINGTON, LA 70433-7515
- **Mailing address phone:** (985) 687-1616
- **Mailing address fax:** (888) 920-7457

## 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:** 05/19/2021
- **Last updated:** 05/19/2021