Organization
NEPA DENTAL GROUP, INC
Active
Other names
NEPA Dental - West
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN ALBERT COSTELLO DMD (VICE PRESIDENT)
(570) 655-7645
Entity
Organization
Contact information
Practice address
920 WYOMING AVE STE 104, FORTY FORT, PA 18704-3970
(570) 283-2422
(570) 283-1492
Mailing address
457 N MAIN ST STE 100, PITTSTON, PA 18640-2185
(570) 655-7645
(570) 299-7427
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
08/05/2020
Last updated
08/05/2020
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