Michael R Wiesner, D.D.S

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5831 Issued in LA

Practice address

385 Bert Kouns Loop Ste 700
Shreveport, LA 71106-8163

Phone

(318) 688-9330

NPI assigned

Jun 8, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Michael R. Wiesner DDS LLC

  • General Practice Dentistry
  • Shreveport, LA
  • NPI 1750101606
  NPD
• A Brighter Smile

  • General Practice Dentistry
  • Shreveport, LA
  • NPI 1366822710
  NPD (past)

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

{
    "created_epoch": "1181260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741651200000",
    "number": "1154524817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "385 BERT KOUNS LOOP STE 700",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711068163",
            "telephone_number": "318-779-1254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "385 BERT KOUNS LOOP STE 700",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711068163",
            "telephone_number": "318-688-9330"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10450 Ellerbe Rd",
            "address_purpose": "LOCATION",
            "city": "Shreveport",
            "state": "LA",
            "postal_code": "711068163",
            "country_code": "US",
            "telephone_number": "318-688-9330",
            "fax_number": "318-212-6539",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WIESNER",
        "first_name": "MICHAEL",
        "middle_name": "R",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-08",
        "last_updated": "2025-03-11",
        "certification_date": "2025-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "LA",
            "license": "5831",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "LA",
            "license": "5831",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Delisia Wicks
• Karen A Widaman, RPH
• Molly C Wierick, LOTR
• Trent W Wierick, P.T.
• Rachel Wieschhaus
• Thuy Wiesner, D.D.S
• Heather A Wiggins, PSS
• Jonathan Wayne Wiggins, LPC
• Nicolette Fashay Wiggins
• Sherman S Wiggins, M.D.

• General Practice Dentistry in Shreveport, LA
• Providers in Shreveport, LA by specialty
• General Practice Dentistry in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.