Individual
WESLEY D. CARLISLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, DMD
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)
7256
LA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
302556
LA
Other
Enumeration date
04/28/2015
Last updated
08/19/2021
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