# NEPA DENTAL GROUP - WILKES BARRE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124477880
- **Authorized official:** DR. JOHN COSTELLO DMD (VICE PRESIDENT)
- **Authorized official phone:** (570) 401-1783

## Contact information

- **Practice address:** 213 E MARKET ST, WILKES BARRE, PA 18702-5234
- **Practice address phone:** (570) 825-9645
- **Mailing address:** 457 N MAIN ST, SUITE 100, PITTSTON, PA 18640-2183

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 06/03/2016
- **Last updated:** 06/03/2016