NPIMap

Organization Active NPI

Arklatex Oral & Maxillofacial Surgery a Partnership of Professional de

  • Oral and Maxillofacial Surgery (Dentist)
  • Shreveport, LA
National Provider Identifier
1003092545
Registry record updated Feb 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
ARKLATEX ORAL & MAXILLOFACIAL SURGERY A PARTNERSHIP OF PROFESSIONAL DE
Practice address
7600 Fern Ave
Building 1400
Shreveport, LA 71105-5659
Phone
(318) 797-5812
NPI assigned
Jan 15, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Brian R Smith, DDS, MSNPI 1639191182
Title
President
Phone
(318) 797-5812

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X Primary

Addresses

Primary practice location

7600 Fern Ave
Building 1400
Shreveport, LA 71105-5659

Mailing address

7600 Fern Ave
Building 1400
Shreveport, LA 71105-5659
Phone (318) 797-5812

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101215000126 LA Part B Supplier - Clinic/Group Practice 9739376864 Receives reassigned benefits from 6 practitioners
Practice locations: Bossier City, LA; Shreveport, LA

National Provider Directory

National Provider Directory

Locations

1050 Bancorp South Cir
Ste 400
Bossier City, LA 71111
Phone (318) 747-5812

2125 E Bert Kouns Industrial Loop
Shreveport, LA 71105
Phone (318) 401-1766

7600 Fern Ave
Ste 600
Shreveport, LA 71105
Phone (318) 797-5812

7600 Fern Ave
Ste 1400
Shreveport, LA 71105
Phone (318) 797-5812

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1200355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296604800000",
    "number": "1003092545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7600 FERN AVE",
            "address_2": "BUILDING 1400",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055659",
            "telephone_number": "318-797-5812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7600 FERN AVE",
            "address_2": "BUILDING 1400",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055659",
            "telephone_number": "318-797-5812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARKLATEX ORAL & MAXILLOFACIAL SURGERY A PARTNERSHIP OF PROFESSIONAL DE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-15",
        "last_updated": "2011-02-02",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "318-797-5812",
        "authorized_official_credential": "DDS, MS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.