Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

LSU Health Sciences Center Shreveport Faculty Group Practice

Organization Oral & Maxillofacial Surgery (D.M.D.) · NPI 1013374222

LSU Health Sciences Center Shreveport Faculty Group Practice is an Oral & Maxillofacial Surgery (D.M.D.) in Shreveport, Louisiana. Registered with an NPI since 2016.

In the registry since
2016
Specialties on file
15

Practice location Address checks out

1541 Kings Hwy
Shreveport, LA 71103-4228
Phone: (318) 626-0000
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X
Oral & Maxillofacial Surgery (D.M.D.) Taxonomy 204E00000X
Anesthesiology Physician Taxonomy 207L00000X
Emergency Medicine Physician Taxonomy 207P00000X
Internal Medicine Physician Taxonomy 207R00000X
Neurological Surgery Physician Taxonomy 207T00000X
Obstetrics & Gynecology Physician Taxonomy 207V00000X
Ophthalmology Physician Taxonomy 207W00000X
Orthopaedic Surgery Physician Taxonomy 207X00000X
Otolaryngology Physician Taxonomy 207Y00000X
Pediatrics Physician Taxonomy 208000000X
Neurology Physician Taxonomy 2084N0400X
Psychiatry Physician Taxonomy 2084P0800X
Surgery Physician Taxonomy 208600000X
Urology Physician Taxonomy 208800000X

Record details

NPI number1013374222
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Mitzi Green — Director · (318) 626-0000
NPI enumeratedJanuary 19, 2016
Last updated in NPPESJune 28, 2023
Certification dateJune 28, 2023
Mailing address1512 W Kirby Pl, Shreveport, LA 71103-3822

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