Healthcare Provider Details

I. General information

NPI: 1588641096
Provider Name (Legal Business Name): ALEXANDRIA ORAL SURGERY ASSOCIATES LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 06/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 PETERMAN DR
ALEXANDRIA LA
71301-3433
US

IV. Provider business mailing address

1403 PETERMAN DR
ALEXANDRIA LA
71301-3433
US

V. Phone/Fax

Practice location:
  • Phone: 318-443-7208
  • Fax: 318-443-0046
Mailing address:
  • Phone: 318-443-7208
  • Fax: 318-443-0046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID M CARLTON JR.
Title or Position: PARTNER
Credential: DDS
Phone: 318-443-7208