Provider Demographics
NPI:1275698508
Name:FAMILY DENTISTRY
Entity Type:Organization
Organization Name:FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EDGARDO
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:RABEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:225-775-0160
Mailing Address - Street 1:3114 GROOM RD
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:LA
Mailing Address - Zip Code:70714-3402
Mailing Address - Country:US
Mailing Address - Phone:225-775-0160
Mailing Address - Fax:225-775-0230
Practice Address - Street 1:3114 GROOM RD
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:LA
Practice Address - Zip Code:70714-3402
Practice Address - Country:US
Practice Address - Phone:225-775-0160
Practice Address - Fax:225-775-0230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA17241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA=========OtherTAX IDENTIFICATION NUMBER