Individual
DR. FAYE MARIE KOSTIDIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1555 N CLINE AVE, GRIFFITH, IN 46319-1567
(219) 838-0256
(219) 838-2025
Mailing address
1555 N CLINE AVE, GRIFFITH, IN 46319-1567
(219) 838-0256
(219) 838-2025
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12010629A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200308730
—
IN
Enumeration date
10/06/2006
Last updated
07/08/2007
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