Individual provider Active NPI

Connor Luke Costello, DDS

  • General Practice Dentistry
  • Monroe, LA
National Provider Identifier
1508659624
Registry record updated May 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
7661 Issued in LA
Practice address
2016 Tower Dr
Monroe, LA 71201-5036
Phone
(318) 387-5732
NPI assigned
May 22, 2025
Last updated
May 22, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 22, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 7661 LA Primary

Addresses

Primary practice location

2016 Tower Dr
Monroe, LA 71201-5036

Mailing address

2016 Tower Dr
Monroe, LA 71201-5036
Phone (318) 387-5732

Other practice location 1

7699 Highway 2
Farmerville, LA 71241-6165
Phone (318) 368-9518

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
7661LAMDCounselor

Practice roles

OrganizationSpecialtyStatusNew patients
Nela Dental of Monroe, LLC CurrentSince May 25, 2025 Accepting new patients
Nela Sleep PLLC General Practice CurrentSince May 25, 2025 Accepting new patients

Locations

2016 Tower Dr
Monroe, LA 71201
Phone (318) 387-5432

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1747872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747872000000",
    "number": "1508659624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2016 TOWER DR",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712015036",
            "telephone_number": "318-387-5732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2016 TOWER DR",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712015036",
            "telephone_number": "318-387-5732"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7699 Highway 2",
            "address_purpose": "LOCATION",
            "city": "Farmerville",
            "state": "LA",
            "postal_code": "712416165",
            "country_code": "US",
            "telephone_number": "318-368-9518",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COSTELLO",
        "first_name": "CONNOR",
        "middle_name": "LUKE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-05-22",
        "last_updated": "2025-05-22",
        "certification_date": "2025-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "LA",
            "license": "7661",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Monroe, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.