| Nela Dental Of Farmerville, Llc | |
|
7699 Highway 2 Farmerville LA 71241-6165 | |
| (318) 368-9518 | |
| (318) 368-4480 |
| Full Name | Nela Dental Of Farmerville, Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 7699 Highway 2, Farmerville, Louisiana |
| Authorized Official Name and Position | Carla Dawn Costello (BUSINESS MANAGER) |
| Authorized Official Contact | 3187370965 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Nela Dental Of Farmerville, Llc 7699 Highway 2 Farmerville LA 71241-6165 Ph: (318) 368-9518 | Nela Dental Of Farmerville, Llc 7699 Highway 2 Farmerville LA 71241-6165 Ph: (318) 368-9518 |
| NPI Number | 1881968402 |
|---|---|
| Provider Enumeration Date | 02/29/2012 |
| Last Update Date | 02/21/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881968402 | NPI | - | NPPES |
| 26171 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 5630 (Louisiana) | Secondary |
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
Robert Vance Costello, Dds, Apdc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 7699 Highway 2, Farmerville, LA 71241 Phone: 318-368-9518 Fax: 318-368-4480 |