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Individual

MR. FREDRICK WILLIAM COSTELLO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.D.S.

Contact information

Practice address
1089 W GRANADA BLVD, SUITE 1, ORMOND BEACH, FL 32174-8116
(386) 673-1611
(386) 672-3543
Mailing address
1089 W GRANADA BLVD, SUITE 1, ORMOND BEACH, FL 32174-8116
(386) 673-1611
(386) 672-3543

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN6323
FL

Other

Enumeration date
08/15/2006
Last updated
07/08/2007
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