| NPI | 1245906148 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WESLEY D. CARLISLE Oral And Maxillofacial Surgeon 318-865-0249 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2021-08-19 |
| Last Update Date | 2021-08-19 |