Wesley D. Carlisle, MD, DMD

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

302556 Issued in LA

Practice address

915 Shreveport Barksdale Hwy
Shreveport, LA 71105-2205

Phone

(318) 865-0249

Fax

(318) 869-0026

NPI assigned

Apr 28, 2015

Sex

Male

Sole proprietor

No

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

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

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

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Shreveport, LA
  • NPI 1245906148

  Oral and Maxillofacial Surgery

  NPD Authorized official

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

{
    "created_epoch": "1430179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629331200000",
    "number": "1346627445",
    "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": {
        "last_name": "CARLISLE",
        "first_name": "WESLEY",
        "middle_name": "D.",
        "credential": "MD, DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-28",
        "last_updated": "2021-08-19",
        "certification_date": "2021-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "LA",
            "license": "7256",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "LA",
            "license": "302556",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Carinio Jr., CIT
• Charles Richard Carleton, MSN, FNP-C
• Dustin Ross Carlisle, NP-C
• Kelly Morgan Carlisle, M.D.
• Lane S Carlisle, NP
• Harry Carmack
• Carmichael'S Cashway Pharmacy, Inc.
• John B Carmody
• Andre' Jacob Carpenter, P.A.
• Ernest Carpenter III, LOTR

• Oral & Maxillofacial Surgery (D.M.D.) in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Louisiana

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.