Organization
WK ORAL AND MAXILLOFACIAL SURGERY INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY JANE WARD (SENIOR VP FINANCE)
(318) 716-4937
Entity
Organization
Contact information
Practice address
2508 BERT KOUNS INDUSTRIAL LOOP STE 410, SHREVEPORT, LA 71118-3157
(318) 716-4939
Mailing address
2508 BERT KOUNS INDUSTRIAL LOOP STE 410, SHREVEPORT, LA 71118-3157
(318) 716-4939
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
12/02/2021
Last updated
03/04/2026
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