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General NPI Number Information
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NPI Number | 1275698508
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Entity Type | Organization
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Legal Business Name | FAMILY DENTISTRY
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 3114 GROOM RD
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City | BAKER
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State | LA
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Zip | 70714-3402
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Country | US
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Telephone | 225-775-0160
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Fax | 225-775-0230
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Provider Business Mailing Address
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Address Line | 3114 GROOM RD
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City | BAKER
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State | LA
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Zip | 70714-3402
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Country | US
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Telephone | 225-775-0160
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Fax | 225-775-0230
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Authorized Official
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Title or Position | DENTIST
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Name | DR. EDGARDO LOUIS RABEL
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Credential | DDS
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Telephone | 225-775-0160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | LA1724
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License Number State | LA
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