Individual
JOHN ROBERT COSTELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
400 BROADWAY, NEWPORT, RI 02840-1733
(401) 849-8433
Mailing address
400 BROADWAY, NEWPORT, RI 02840-1733
(401) 849-8433
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1818
RI
Other
Enumeration date
11/06/2008
Last updated
11/06/2008
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