Individual
DR. JOHN M COSTLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
500 FOOTHILL DR., SALT LAKE CITY, UT 84148
(801) 584-1206
Mailing address
1214 E. SHERWOOD DR, KAYSVILLE, UT 84037
(801) 546-0400
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
275085-9923
UT
Other
Enumeration date
10/05/2006
Last updated
07/08/2007
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