Organization
GRANT PARK DENTAL, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL COSTELLO DDS (OWNER)
(414) 764-6070
Entity
Organization
Contact information
Practice address
1333 COLLEGE AVE, SUITE C, SOUTH MILWAUKEE, WI 53172-1150
(414) 764-6070
(414) 764-3035
Mailing address
1333 COLLEGE AVE, SUITE C, SOUTH MILWAUKEE, WI 53172-1150
(414) 764-6070
(414) 764-3035
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2736
WI
Other
Enumeration date
11/27/2013
Last updated
11/27/2013
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