Individual
DR. PETER A. COSTALOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
462 BAY RIDGE PKWY, BROOKLYN, NY 11209-2702
(718) 238-9888
Mailing address
462 BAY RIDGE PKWY, BROOKLYN, NY 11209-2702
(718) 238-9888
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
049776
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02395435
—
NY
Enumeration date
12/16/2006
Last updated
07/08/2007
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