Individual
DR. CHANDA J COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
10211 SW PARK WAY, PORTLAND, OR 97225-5009
(503) 203-6978
Mailing address
10211 SW PARK WAY, PORTLAND, OR 97225-5009
(503) 203-6978
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D9133
OR
Other
Enumeration date
08/13/2008
Last updated
03/05/2017
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