=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841585981
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERNEST L. COSTELLO D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2011
-----------------------------------------------------
Last Update Date | 12/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1510 N ARLINGTON HEIGHTS RD
-----------------------------------------------------
City | ARLINGTON HEIGHTS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60004-3906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-259-1111
-----------------------------------------------------
Fax | 847-259-2222
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1510 N ARLINGTON HEIGHTS RD
-----------------------------------------------------
City | ARLINGTON HEIGHTS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60004-3906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-259-1111
-----------------------------------------------------
Fax | 847-259-2222
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 019028668
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------