Organization
COSMET ENTERPRISE LLC
Active
Other names
Magnolia Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES P COSTELLO DDS (MEMBER)
(352) 408-1400
Entity
Organization
Contact information
Practice address
10250 SE 167TH PLACE RD, SUITE 3, SUMMERFIELD, FL 34491-8682
(352) 245-0780
(352) 347-8369
Mailing address
10250 SE 167TH PLACE RD, SUITE 3, SUMMERFIELD, FL 34491-8682
(352) 245-0780
(352) 347-8369
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
03/26/2008
Last updated
03/26/2008
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