WK Oral and Maxillofacial Surgery Institute

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

WK ORAL AND MAXILLOFACIAL SURGERY INSTITUTE

Practice address

2508 Bert Kouns Industrial Loop Ste 410
Shreveport, LA 71118-3157

Phone

(318) 716-4939

NPI assigned

Dec 2, 2021

Organization subpart

No

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

Authorized official

Name

Mary Jane Ward

Title

Senior VP Finance

Phone

(318) 716-4937

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Willis Knighton Medical Center, Inc.

  • Skilled Nursing Facility
  • Shreveport, LA
  • NPI 1144267451

  Member Of

  NPD member

Locations

Practitioners 4

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

• Ross David Brockman, DMD

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Shreveport, LA
  • NPI 1427587054
  Medicare reassignment Care Compare group NPD
• Ghali Elias Ghali, DDS, MD

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Shreveport, LA
  • NPI 1417981739

  Oral and Maxillofacial Surgery

  Medicare reassignment Care Compare group NPD
• Stavan Yogendra Patel, DDS, MD

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Shreveport, LA
  • NPI 1558688309
  Medicare reassignment Care Compare group NPD
• Brett McCann Shirley, DDS, MD

  • Oral and Maxillofacial Surgery (Dentist)
  • Nacogdoches, TX
  • NPI 1467624973

  LA

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1638403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1772582400000",
    "number": "1104584515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2508 BERT KOUNS INDUSTRIAL LOOP STE 410",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183157",
            "telephone_number": "318-716-4939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2508 BERT KOUNS INDUSTRIAL LOOP STE 410",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183157",
            "telephone_number": "318-716-4939"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2400 Hospital Dr Ste 490",
            "address_purpose": "LOCATION",
            "city": "Bossier City",
            "state": "LA",
            "postal_code": "711112391",
            "country_code": "US",
            "telephone_number": "318-212-7821",
            "fax_number": "318-212-7769",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WK ORAL AND MAXILLOFACIAL SURGERY INSTITUTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-02",
        "last_updated": "2026-03-04",
        "certification_date": "2026-03-04",
        "status": "A",
        "authorized_official_last_name": "WARD",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "JANE",
        "authorized_official_title_or_position": "SENIOR VP FINANCE",
        "authorized_official_telephone_number": "318-716-4937"
    },
    "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": []
}

• WK Northwest Internal Medicine
• WK Northwest Louisiana Infectious Disease Consultants
• WK NW Louisiana Infectious Disease Consultants
• WK OB-GYN Associates of Shreveport
• WK OB-GYN Concepts
• WK Orthopedic Clinic
• WK Orthopedic Specialty Center
• WK Pediatric Eye Specialists
• WK Pediatric Gi Specialists
• WK Pediatric Health & Wellness

• Oral and Maxillofacial Surgery (Dentist) in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.