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WK ORAL AND MAXILLOFACIAL SURGERY INSTITUTE
NPI 1104584515
Dentist - Oral and Maxillofacial Surgery in Shreveport, LA

Active since December 02, 2021CLIA 19D2096429 · Waiver
2508 BERT KOUNS INDUSTRIAL LOOP STE 410, SHREVEPORT, LA 71118(318) 716-4939 Get Directions Write a Review

NPPES record last updated: March 4, 2026. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Mar 4, 2026, Dec 2, 2021 (2 updates tracked since 2021).

About Wk Oral And Maxillofacial Surgery Institute NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WK ORAL AND MAXILLOFACIAL SURGERY INSTITUTE (NPI 1104584515) is a healthcare organization registered as an oral and maxillofacial surgery in Shreveport, Louisiana and active in the NPI registry since December 2021. The organization holds a CLIA Waiver certificate valid through May 25, 2027, maintains a secondary practice location in Bossier City, and lists Mary Jane Ward, Senior Vp Finance, as its authorized official.

NPPES Registry Identity

NPI1104584515
Entity TypeOrganization
Primary Taxonomy1223S0112X
Legal Business NameWK ORAL AND MAXILLOFACIAL SURGERY INSTITUTE
Location Address2508 BERT KOUNS INDUSTRIAL LOOP STE 410Shreveport, LA 71118-3157
Mailing Address2508 Bert Kouns Industrial Loop Ste 410Shreveport, LA 71118-3157 · (318) 716-4939
Phone(318) 716-4939
Organization SubpartNo
Authorized OfficialMary Jane WardSenior Vp Finance · (318) 716-4937
Enumeration DateDecember 2, 2021
Last NPPES UpdateMarch 4, 20262 updates tracked since enumeration
NPPES CertifiedMarch 4, 2026
✔ NPI 1104584515 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers
Taxonomy Code1223S0112X
Definition
An oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
2508 BERT KOUNS INDUSTRIAL LOOP STE 410, Shreveport, LA 71118
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Secondary Practice Location 1

Location 12400 Hospital Dr Ste 490Bossier City, LA 71111-2391 · Phone (318) 212-7821 · Fax (318) 212-7769

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Magnolia Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 19D2096429

Wk Oral Maxillofacial Surgery Institute · Bossier City, LA
Active · expires May 25, 2027
CLIA Number19D2096429
Laboratory TypePhysician Office
Certificate Effective DateMay 26, 2025
Certificate Expiration DateMay 25, 2027
Laboratory DirectorGloli Ghali
Laboratory Phone(318) 212-7821
Laboratory LocationWk Oral Maxillofacial Surgery Institute2400 Hospital Drive, Suite 490, Bossier City, LA 71111
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ROSS DAVID BROCKMAN DMD
Oral & Maxillofacial Surgery
2508 BERT KOUNS INDUSTRIAL LOOP STE 410
SHREVEPORT, LA 71118
Caddo Parish (318) 212-5944
STAVAN YOGENDRA PATEL DDS, MD
Oral & Maxillofacial Surgery
2508 BERT KOUNS INDUSTRIAL LOOP STE 410
SHREVEPORT, LA 71118
Caddo Parish (318) 212-5944
MAYANKKUMAR SAMIRKUMAR PATEL
Student in an Organized Health Care Education/Training Program
2508 BERT KOUNS INDUSTRIAL LOOP STE 410
SHREVEPORT, LA 71118
Caddo Parish (318) 212-5944

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Wk Oral And Maxillofacial Surgery Institute's NPI number?

The NPI number for Wk Oral And Maxillofacial Surgery Institute is 1104584515. It was assigned to this organization in the NPPES registry on December 2, 2021.

Where is Wk Oral And Maxillofacial Surgery Institute located?

Wk Oral And Maxillofacial Surgery Institute is located at 2508 Bert Kouns Industrial Loop Ste 410, Shreveport, LA 71118. The listed phone number is (318) 716-4939.

What is Wk Oral And Maxillofacial Surgery Institute's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Does Wk Oral And Maxillofacial Surgery Institute hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 19D2096429) is associated with this NPI, valid through May 25, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Wk Oral And Maxillofacial Surgery Institute accept?

Health plans from Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Magnolia Health, Ambetter from Superior HealthPlan and Blue Cross and Blue Shield of Louisiana and 1 other insurer list Wk Oral And Maxillofacial Surgery Institute as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Wk Oral And Maxillofacial Surgery Institute was last updated on March 4, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.