Individual
DR. JACLYN KOSTELAC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
3320 RUTGER ST, SAINT LOUIS, MO 63104-1122
(314) 977-8363
Mailing address
3300 KOSTELAC LN, BELLEVILLE, IL 62223-7728
(618) 910-3835
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
06/22/2015
Last updated
06/22/2015
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