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General NPI Number Information
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NPI Number | 1164864765
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Entity Type | Individual
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Provider Name | JAMES A COSTIS DDS
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Gender | Male
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Dates
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Enumeration Date | 07/24/2013
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Last Update Date | 10/15/2020
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Provider Practice Location Address
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Address Line | 5456 N MILWAUKEE AVE
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City | CHICAGO
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State | IL
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Zip | 60630-1225
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Country | US
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Telephone | 773-631-5693
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Fax | 773-631-0058
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Provider Business Mailing Address
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Address Line | 5456 N MILWAUKEE AVE
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City | CHICAGO
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State | IL
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Zip | 60630-1225
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Country | US
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Telephone | 773-631-5693
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Fax | 773-631-0058
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019022103
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License Number State | IL
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