Individual
ROBERT COSTISEVSCHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4422 3RD AVE, BRONX, NY 10457-2545
(718) 960-9000
Mailing address
313 WARWICK DR, WALNUT CREEK, CA 94598-4134
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
100501
CA
Other
Enumeration date
05/07/2013
Last updated
11/09/2016
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