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General NPI Number Information
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NPI Number | 1962614537
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Entity Type | Individual
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Provider Name | MARY F. COSTIGAN D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 523 ROUTE 303
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City | ORANGEBURG
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State | NY
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Zip | 10962
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Country | US
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Telephone | 845-359-0407
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Fax |
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Provider Business Mailing Address
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Address Line | 2 FORGE GATE DRIVE UNIT H-8
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City | COLD SPRING
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State | NY
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Zip | 10516
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Country | US
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Telephone | 845-265-3087
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Fax |
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 049520-1
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License Number State | NY
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