Healthcare Provider Details

I. General information

NPI: 1194731836
Provider Name (Legal Business Name): JAMES WILLIAM SIKES JR. DMD, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 08/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6912 FERN LOOP STE A
SHREVEPORT LA
71105-4176
US

IV. Provider business mailing address

6912 FERN LOOP STE A
SHREVEPORT LA
71105-4176
US

V. Phone/Fax

Practice location:
  • Phone: 318-585-7667
  • Fax: 318-585-6912
Mailing address:
  • Phone: 318-585-7667
  • Fax: 318-585-6912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number11117
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number024422
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number51272
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number4912
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: