Organization
NEW JERSEY CENTER FOR ORAL & MAXILLOFACIAL SURGERY
Active
Other names
COSA/Costello Oral Surgery Associates, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL COSTELLO DMD (OWNER)
(201) 712-5556
Entity
Organization
Contact information
Practice address
949 SPRING VALLEY RD, MAYWOOD, NJ 07607-1452
(201) 712-5556
(201) 712-9190
Mailing address
949 SPRING VALLEY RD, MAYWOOD, NJ 07607-1452
(201) 712-5556
(201) 712-9190
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DI19847
NJ
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
DI19847
NJ
Other
Enumeration date
11/09/2012
Last updated
09/15/2015
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