# ORAL SURGERY& DENTAL IMPLANT CENTER OF LOUISIANA

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

## Provider details

- **NPI number:** 1932583358
- **Authorized official:** MR. VANCE G MISURACA DDS (OWNER)
- **Authorized official phone:** (225) 673-1800

## Contact information

- **Practice address:** 16206 AIRLINE HWY, PRAIRIEVILLE, LA 70769-4248
- **Practice address phone:** (225) 766-3300
- **Practice address fax:** (225) 677-9483
- **Mailing address:** 16206 AIRLINE HWY, PRAIRIEVILLE, LA 70769-4248
- **Mailing address phone:** (225) 673-1800
- **Mailing address fax:** (225) 677-9483

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 5051 | LA | Yes |

## Other

- **Enumeration date:** 07/15/2015
- **Last updated:** 08/19/2016