Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.

Shreveport Periodontal Specialists

Organization Periodontics · NPI 1720803356

Shreveport Periodontal Specialists provides Periodontics in Shreveport, Louisiana. Registered with an NPI since 2024.

In the registry since
2024

Practice location Address checks out

745 Edgemont St
Shreveport, LA 71106-2246
Phone: (318) 868-0535
Fax: (318) 868-0572
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Periodontics (primary) Taxonomy 1223P0300X

Record details

NPI number1720803356
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Angela Watson — Coo · (318) 868-0535
NPI enumeratedNovember 19, 2024
Last updated in NPPESNovember 19, 2024
Certification dateNovember 19, 2024
Mailing address745 Edgemont St, Shreveport, LA 71106-2246

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