Healthcare Provider Details

I. General information

NPI: 1497318596
Provider Name (Legal Business Name): SCOTT BELOZER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2019
Last Update Date: 07/05/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 BERT KOUNS INDUSTRIAL LOOP STE D
SHREVEPORT LA
71118-3351
US

IV. Provider business mailing address

2120 BERT KOUNS INDUSTRIAL LOOP STE D
SHREVEPORT LA
71118-3351
US

V. Phone/Fax

Practice location:
  • Phone: 318-687-9800
  • Fax: 318-687-4752
Mailing address:
  • Phone: 318-687-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberS-992
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number36745
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: