Shreveport Periodontal Specialists

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

Legal business name

SHREVEPORT PERIODONTAL SPECIALISTS

Practice address

745 Edgemont St
Shreveport, LA 71106-2246

Phone

(318) 868-0535

Fax

(318) 868-0572

NPI assigned

Nov 19, 2024

Organization subpart

No

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

Authorized official

Name

Angela Watson

Title

Coo

Phone

(318) 868-0535

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Amber Michelle Kreko

  • General Practice Dentistry
  • New Orleans, LA
  • NPI 1649903832
  NPD

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

{
    "created_epoch": "1731974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731974400000",
    "number": "1720803356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "745 EDGEMONT ST",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711062246",
            "telephone_number": "318-868-0535",
            "fax_number": "318-868-0572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "745 EDGEMONT ST",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711062246",
            "telephone_number": "318-868-0535",
            "fax_number": "318-868-0572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHREVEPORT PERIODONTAL SPECIALISTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-19",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-19",
        "status": "A",
        "authorized_official_last_name": "WATSON",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "318-868-0535"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shreveport Manor, LLC
• Shreveport Mental Health
• Shreveport Mental Health Center
• Shreveport Mental Health Center
• Shreveport Oxygen & Rental, LLC
• Shreveport Physical Therapy and Sports Medicine, Inc.
• Shreveport Pregnancy Center
• Shreveport Prime Care Inc
• Shreveport Prosthetics, Inc.
• Shreveport Rehabilitation Hospital, LLC

• Periodontics in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Periodontics in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2024; 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.