Organization
NELA DENTAL OF FARMERVILLE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARLA DAWN COSTELLO (BUSINESS MANAGER)
(318) 737-0965
Entity
Organization
Contact information
Practice address
7699 HIGHWAY 2, FARMERVILLE, LA 71241-6165
(318) 368-9518
(318) 368-4480
Mailing address
7699 HIGHWAY 2, FARMERVILLE, LA 71241-6165
(318) 368-9518
(318) 368-4480
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
5630
LA
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
26171
—
LA
Enumeration date
02/29/2012
Last updated
02/21/2023
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