NPIMap

Organization Active NPI

Michael R. Wiesner DDS LLC

  • General Practice Dentistry
  • Shreveport, LA
National Provider Identifier
1750101606
Registry record updated Oct 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MICHAEL R. WIESNER DDS LLC
Practice address
385 Bert Kouns Loop Ste 700
Shreveport, LA 71106-8163
Phone
(318) 688-9330
Fax
(318) 212-6539
NPI assigned
Oct 15, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2024

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

Authorized official

Name
Inger Whittington
Title
Insurance Billing Lead
Phone
(318) 606-7622

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

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

Mailing address

2557 Viking Dr
Bossier City, LA 71111-2103
Phone (318) 606-7622

Other names 1

  • A Brighter Smile Dental Care Doing business as

National Provider Directory

National Provider Directory

Locations

2557 Viking Dr
Bossier City, LA 71111
Phone (318) 688-9330

Practitioners & affiliated clinicians

Practitioners 5

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": "1728950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728950400000",
    "number": "1750101606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2557 VIKING DR",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711112103",
            "telephone_number": "318-606-7622",
            "fax_number": "318-212-6539"
        },
        {
            "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",
            "fax_number": "318-212-6539"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL R. WIESNER DDS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-15",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "status": "A",
        "authorized_official_last_name": "WHITTINGTON",
        "authorized_official_first_name": "INGER",
        "authorized_official_title_or_position": "INSURANCE BILLING LEAD",
        "authorized_official_telephone_number": "318-606-7622"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "A Brighter Smile Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Oct 15, 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.