Individual
DR. MICHAEL KOSTROV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
234 PLEASANT ST, VIENNA, VA 22180
(703) 255-0405
Mailing address
234 PLEASANT ST, VIENNA, VA 22180
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
13958
MD
Other
Enumeration date
05/01/2007
Last updated
07/08/2007
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