Organization
LOUISIANA ORAL & IMPLANT SURGERY
Active
Other names
Louisiana Oral and Implant Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
NICKOLAS MASKAS DDS, MD (ORAL AND MAXILLOFACIAL SURGEON/OWNE)
(337) 888-4771
Entity
Organization
Contact information
Practice address
4720 LAKE STREET, LAKE CHARLES, LA 70605
(337) 888-4771
(337) 888-4772
Mailing address
4720 LAKE STREET, LAKE CHARLES, LA 70605
(337) 888-4771
(337) 888-4772
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
—
—
Other
Enumeration date
09/18/2019
Last updated
12/23/2019
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