Organization
SHREVEPORT CENTER FOR ORAL AND FACIAL SURGERY, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WESLEY D. CARLISLE MD, DMD (ORAL AND MAXILLOFACIAL SURGEON)
(318) 865-0249
Entity
Organization
Contact information
Practice address
915 SHREVEPORT BARKSDALE HWY, SHREVEPORT, LA 71105-2205
(318) 865-0249
(318) 869-0026
Mailing address
915 SHREVEPORT BARKSDALE HWY, SHREVEPORT, LA 71105-2205
(318) 865-0249
(318) 869-0026
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
—
Other
Enumeration date
08/19/2021
Last updated
08/19/2021
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