MEDICARE: MS. MARIA NASSAR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0106X	Oral and Maxillofacial Pathology Dentistry	S-1221	LA

General Provider Information

NPI Number	:	1265302038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIA NASSAR

Provider Business Mailing Address
First Line	:	2508 BERT KOUNS INDUSTRIAL LOOP STE 403
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71118-3157
Country	:	US
Telephone Number	:	318-780-5312
Fax Number	:

Provider Business Practice Location Address
First Line	:	2508 BERT KOUNS INDUSTRIAL LOOP STE 403
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71118-3157
Country	:	US
Telephone Number	:	318-780-5312
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2025
Last Update Date	:	11/07/2025

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Directions to “ MS. MARIA NASSAR ” Practice Location

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