WK ORAL AND MAXILLOFACIAL SURGERY INSTITUTE
NPI 1104584515
Dentist - Oral and Maxillofacial Surgery in Shreveport, LA
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
Specialties & Licenses
Secondary Practice Location 1
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Wk Oral And Maxillofacial Surgery Institute is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
4Medicare enrollment records show 4 clinicians reassign Medicare billing to Wk Oral And Maxillofacial Surgery Institute, which bills Medicare for the services they deliver. Of these, 3 practice within 10 miles. They are listed nearest first.
Clinicians, nearest first (4)
Shreveport, LA 71118
Shreveport, LA 71118
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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, LAFrequently 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.
Is Wk Oral And Maxillofacial Surgery Institute enrolled in Medicare?
Yes. Wk Oral And Maxillofacial Surgery Institute is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Wk Oral And Maxillofacial Surgery Institute?
According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians in 2 Medicare specialties reassign their Medicare billing to Wk Oral And Maxillofacial Surgery Institute. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Maxillofacial Surgery (3) and Oral and Maxillofacial Surgery (1). Of these, 3 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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 Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, 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 7 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.
# Wk Oral And Maxillofacial Surgery Institute · NPI 1104584515
Oral and Maxillofacial Surgery organization in Shreveport, Louisiana. Organization record, active in the CMS NPPES registry since December 2, 2021.
## Identity
- **NPI:** 1104584515 (Entity type: Organization)
- **Enumerated:** December 2, 2021
- **Primary specialty:** Dentist - Oral and Maxillofacial Surgery · taxonomy 1223S0112X
- **Organization subpart:** No
- **Authorized official:** Mary Ward, SENIOR VP FINANCE
## Practice location
- **Address:** 2508 BERT KOUNS INDUSTRIAL LOOP STE 410, Shreveport, LA 71118-3157
- **Phone:** (318) 716-4939
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 4 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Maxillofacial Surgery (3), Oral and Maxillofacial Surgery (1); 3 practice within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** March 4, 2026
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1104584515) · Data from the CMS NPPES public registry.