# OAK GROVE DENTAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225338593
- **Authorized official:** DR. ROBERT VANCE COSTELLO DDS (CO OWNER)
- **Authorized official phone:** (318) 428-4255

## Contact information

- **Practice address:** 414 ROSS ST, OAK GROVE, LA 71263-9727
- **Practice address phone:** (318) 428-4255
- **Mailing address:** PO BOX 390, OAK GROVE, LA 71263-0390
- **Mailing address phone:** (318) 428-4255

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 5630 | LA | Yes |

## Other

- **Enumeration date:** 11/02/2010
- **Last updated:** 11/02/2010