MEDICARE: JOHN E. COSTELLO DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	23412-875	WI
2	122300000X	Dentist	19-A-12900	IL

General Provider Information

NPI Number	:	1689837825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN E. COSTELLO DDS

Provider Business Mailing Address
First Line	:	779 SUMMER ISLE LN
Second Line	:
City	:	INVERNESS
State	:	IL
Zip	:	60010-5414
Country	:	US
Telephone Number	:	847-259-1111
Fax Number	:

Provider Business Practice Location Address
First Line	:	1640 N ARLINGTON HEIGHTS RD
Second Line	:	SUITE 201
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-3985
Country	:	US
Telephone Number	:	847-259-1111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2008
Last Update Date	:	11/18/2022

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Directions to “ JOHN E. COSTELLO DDS” Practice Location

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