Healthcare Provider Details

I. General information

NPI: 1295611093
Provider Name (Legal Business Name): WBOMS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 10TH ST
MARRERO LA
70072-3013
US

IV. Provider business mailing address

3100 GALLERIA DR STE 202
METAIRIE LA
70001-2196
US

V. Phone/Fax

Practice location:
  • Phone: 504-217-5717
  • Fax: 504-217-5941
Mailing address:
  • Phone: 504-456-5033
  • Fax: 504-456-5057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL HYNEMAN
Title or Position: OWNER
Credential: D.D.S.,M.D.
Phone: 504-217-5717