Healthcare Provider Details

I. General information

NPI: 1275698508
Provider Name (Legal Business Name): FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3114 GROOM RD
BAKER LA
70714-3402
US

IV. Provider business mailing address

3114 GROOM RD
BAKER LA
70714-3402
US

V. Phone/Fax

Practice location:
  • Phone: 225-775-0160
  • Fax: 225-775-0230
Mailing address:
  • Phone: 225-775-0160
  • Fax: 225-775-0230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberLA1724
License Number StateLA

VIII. Authorized Official

Name: DR. EDGARDO LOUIS RABEL
Title or Position: DENTIST
Credential: DDS
Phone: 225-775-0160