Individual
DR. EDMUND J COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1698 CENTRE ST, WEST ROXBURY, MA 02132-1240
(617) 327-9656
(781) 769-0599
Mailing address
1698 CENTRE ST, WEST ROXBURY, MA 02132-1240
(617) 327-9656
(781) 769-0599
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
MA10764
MA
Other
Enumeration date
08/02/2006
Last updated
07/08/2007
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