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General NPI Number Information
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NPI Number | 1881968402
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Entity Type | Organization
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Legal Business Name | NELA DENTAL OF FARMERVILLE, LLC
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Dates
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Enumeration Date | 02/29/2012
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Last Update Date | 02/21/2023
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Provider Practice Location Address
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Address Line | 7699 HIGHWAY 2
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City | FARMERVILLE
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State | LA
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Zip | 71241-6165
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Country | US
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Telephone | 318-368-9518
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Fax | 318-368-4480
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Provider Business Mailing Address
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Address Line | 7699 HIGHWAY 2
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City | FARMERVILLE
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State | LA
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Zip | 71241-6165
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Country | US
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Telephone | 318-368-9518
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Fax | 318-368-4480
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | CARLA DAWN COSTELLO
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Credential |
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Telephone | 318-737-0965
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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 | 5630
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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