Organization
WK ORAL AND MAXILLOFACIAL SURGERY INSTITUTE
Active
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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