Organization
NEPA DENTAL GROUP - WILKES BARRE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN COSTELLO DMD (VICE PRESIDENT)
(570) 401-1783
Entity
Organization
Contact information
Practice address
213 E MARKET ST, WILKES BARRE, PA 18702-5234
(570) 825-9645
Mailing address
457 N MAIN ST, SUITE 100, PITTSTON, PA 18640-2183
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
06/03/2016
Last updated
06/03/2016
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