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Organization
OFELIA K. COSTALES, D.D.S., INC.
Active
Organization
OFELIA K. COSTALES, D.D.S., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OFELIA KARAAN COSTALES D.D.S. (PRESIDENT/OWNER)
(310) 518-6802
Entity
Organization
Contact information
Practice address
23517 SOUTH MAIN ST STE 102, CARSON, CA 90745
(310) 518-6802
Mailing address
23517 SOUTH MAIN ST STE 102, CARSON, CA 90745
(310) 518-6802
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
48250
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
522096
DENTICAL PIN
CA
Enumeration date
07/09/2012
Last updated
07/09/2012
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