Individual
CORY J COSTANZO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
7104 N FRESNO ST, 101, FRESNO, CA 93720-2970
(559) 439-2147
Mailing address
1922 N GRAYBARK AVE, CLOVIS, CA 93619-9590
(559) 297-4086
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
50234
CA
Other
Enumeration date
04/26/2007
Last updated
07/08/2007
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