| NPI | 1932098613 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER JOSEPH COSTELLO Owner 502-308-4546 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2025-06-30 |
| Last Update Date | 2025-06-30 |