Individual
LISA COSTELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DENTAL HYGIENIST
Contact information
Practice address
326 N. FERRY ST, GRAND HAVEN, MI 49417
(616) 846-2701
(616) 246-8009
Mailing address
326 N. FERRY ST, GRAND HAVEN, MI 49417
(616) 846-2701
(616) 246-8009
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
2902011931
MI
Other
Enumeration date
11/05/2015
Last updated
11/05/2015
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