Healthcare Provider Details

I. General information

NPI: 1700118510
Provider Name (Legal Business Name): JAMES W. SIKES, JR. DMD, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 02/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 E BERT KOUNS LOOP
SHREVEPORT LA
71105-5634
US

IV. Provider business mailing address

1455 E BERT KOUNS LOOP
SHREVEPORT LA
71105-5634
US

V. Phone/Fax

Practice location:
  • Phone: 318-798-4466
  • Fax: 318-798-4543
Mailing address:
  • Phone: 318-798-4466
  • Fax: 318-798-4543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number4912
License Number StateLA

VIII. Authorized Official

Name: DR. JAMES W SIKES JR.
Title or Position: DMD, MD/OWNER
Credential: DMD, MD
Phone: 318-798-4466