Provider Demographics
NPI:1427760446
Name:LOUISIANA ORAL SURGERY CENTER - DOCTORS ROBERT LEO REGAN, MICHAEL CHAR
Entity type:Organization
Organization Name:LOUISIANA ORAL SURGERY CENTER - DOCTORS ROBERT LEO REGAN, MICHAEL CHAR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:WYATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-766-5413
Mailing Address - Street 1:5227 FLANDERS DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-9169
Mailing Address - Country:US
Mailing Address - Phone:225-766-5413
Mailing Address - Fax:225-767-3275
Practice Address - Street 1:14169 HIGHWAY 73 UNIT A
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-3614
Practice Address - Country:US
Practice Address - Phone:225-766-5413
Practice Address - Fax:225-767-3275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-21
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1073931929OtherNELSON NPI
LA6444OtherSTATE LICENSE