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Organization
OAK GROVE DENTAL
Active
Organization
OAK GROVE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT VANCE COSTELLO DDS (CO OWNER)
(318) 428-4255
Entity
Organization
Contact information
Practice address
414 ROSS ST, OAK GROVE, LA 71263-9727
(318) 428-4255
Mailing address
PO BOX 390, OAK GROVE, LA 71263-0390
(318) 428-4255
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5630
LA
Other
Enumeration date
11/02/2010
Last updated
11/02/2010
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