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Organization
ORAL SURGERY& DENTAL IMPLANT CENTER OF LOUISIANA
Active
Organization
ORAL SURGERY& DENTAL IMPLANT CENTER OF LOUISIANA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VANCE G MISURACA DDS (OWNER)
(225) 673-1800
Entity
Organization
Contact information
Practice address
16206 AIRLINE HWY, PRAIRIEVILLE, LA 70769-4248
(225) 766-3300
(225) 677-9483
Mailing address
16206 AIRLINE HWY, PRAIRIEVILLE, LA 70769-4248
(225) 673-1800
(225) 677-9483
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
5051
LA
Other
Enumeration date
07/15/2015
Last updated
08/19/2016
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