Organization
THE DOWNTOWN DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL L COSTELLO DDS (OWNER)
(414) 278-6070
Entity
Organization
Contact information
Practice address
161 W WISCONSIN AVE, SUITE 5036, MILWAUKEE, WI 53203-2602
(414) 278-6070
(414) 278-6087
Mailing address
161 W WISCONSIN AVE, SUITE 5036, MILWAUKEE, WI 53203-2602
(414) 278-6070
(414) 278-6087
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
2736
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38373000
—
WI
Enumeration date
11/07/2006
Last updated
08/22/2020
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