Oak Grove Dental | |
414 Ross St Oak Grove LA 71263-9727 | |
(318) 428-4255 | |
Not Available |
Full Name | Oak Grove Dental |
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Speciality | Dentist - General Practice |
Location | 414 Ross St, Oak Grove, Louisiana |
Authorized Official Name and Position | Robert Vance Costello (CO OWNER) |
Authorized Official Contact | 3184284255 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Oak Grove Dental Po Box 390 Oak Grove LA 71263-0390 Ph: (318) 428-4255 | Oak Grove Dental 414 Ross St Oak Grove LA 71263-9727 Ph: (318) 428-4255 |
NPI Number | 1225338593 |
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Provider Enumeration Date | 11/02/2010 |
Last Update Date | 11/02/2010 |
Identifier | Type | State | Issuer |
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1225338593 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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1223G0001X | Dentist - General Practice | 5630 (Louisiana) | Primary |