Provider Demographics
NPI:1992051007
Name:ASCENSION ORAL SURGERY, LLC
Entity type:Organization
Organization Name:ASCENSION ORAL SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL AND MAXILLOFACIAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:JOSEPHS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:225-744-2660
Mailing Address - Street 1:16260 AIRLINE HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-4272
Mailing Address - Country:US
Mailing Address - Phone:225-744-2660
Mailing Address - Fax:225-744-2666
Practice Address - Street 1:16260 AIRLINE HWY
Practice Address - Street 2:SUITE A
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-4272
Practice Address - Country:US
Practice Address - Phone:225-744-2660
Practice Address - Fax:225-744-2666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA62961223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty