| Oak Grove Dental | |
|
414 Ross St Oak Grove LA 71263-9727 | |
| (318) 428-4255 | |
| Not Available |
| Full Name | Oak Grove Dental |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| Provider Enumeration Date | 11/02/2010 |
| Last Update Date | 11/02/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225338593 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 5630 (Louisiana) | Primary |