Healthcare Provider Details

I. General information

NPI: 1457578239
Provider Name (Legal Business Name): ORAL SURGERY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 FORSYTHE AVE
MONROE LA
71201-3608
US

IV. Provider business mailing address

2003 FORSYTHE AVE
MONROE LA
71201-3608
US

V. Phone/Fax

Practice location:
  • Phone: 318-388-2621
  • Fax: 318-388-2835
Mailing address:
  • Phone: 318-388-2621
  • Fax: 318-388-2835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number3287
License Number StateLA

VIII. Authorized Official

Name: DR. ERIC T. GEIST
Title or Position: DOCTOR
Credential: DDS
Phone: 318-388-2621