NPIMap

Organization Active NPI

Shreveport Center for Oral and Facial Surgery, L.L.C.

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Shreveport, LA
National Provider Identifier
1245906148
Registry record updated Aug 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X
Legal business name
SHREVEPORT CENTER FOR ORAL AND FACIAL SURGERY, L.L.C.
Practice address
915 Shreveport Barksdale Hwy
Shreveport, LA 71105-2205
Phone
(318) 865-0249
Fax
(318) 869-0026
NPI assigned
Aug 19, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2021

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

Authorized official

Name
Dr. Wesley D. Carlisle, MD, DMDNPI 1346627445
Title
Oral and Maxillofacial Surgeon
Phone
(318) 865-0249

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193200000X MULTI-SPECIALTY GROUP 1223S0112X
Oral & Maxillofacial Surgery (D.M.D.)Group: 193200000X MULTI-SPECIALTY GROUP 204E00000X Primary

Addresses

Primary practice location

915 Shreveport Barksdale Hwy
Shreveport, LA 71105-2205

Mailing address

915 Shreveport Barksdale Hwy
Shreveport, LA 71105-2205
Phone (318) 865-0249

National Provider Directory

National Provider Directory

Locations

915 Shreveport Barksdale Hwy
Shreveport, LA 71105
Phone (318) 865-0249

Practitioners & affiliated clinicians

Practitioners 2

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": "1629331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629331200000",
    "number": "1245906148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 SHREVEPORT BARKSDALE HWY",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711052205",
            "telephone_number": "318-865-0249",
            "fax_number": "318-869-0026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 SHREVEPORT BARKSDALE HWY",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711052205",
            "telephone_number": "318-865-0249",
            "fax_number": "318-869-0026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHREVEPORT CENTER FOR ORAL AND FACIAL SURGERY, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-19",
        "last_updated": "2021-08-19",
        "certification_date": "2021-08-19",
        "status": "A",
        "authorized_official_last_name": "CARLISLE",
        "authorized_official_first_name": "WESLEY",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "ORAL AND MAXILLOFACIAL SURGEON",
        "authorized_official_telephone_number": "318-865-0249",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD, DMD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Oral & 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 Aug 19, 2021; 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.