MEDICARE: DILLON COSTANTINO DENTAL PARTNERSHIP

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1750083887
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DILLON COSTANTINO DENTAL PARTNERSHIP

Provider Business Mailing Address
First Line	:	10505 W PICO BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-2319
Country	:	US
Telephone Number	:	310-475-0617
Fax Number	:

Provider Business Practice Location Address
First Line	:	10505 W PICO BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-2319
Country	:	US
Telephone Number	:	310-475-0617
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PARTNER
Name	:	DR. LINDSAY COSTANTINO
Credential	:	DDS
Telephone Number	:	310-475-0617

Provider Enumeration Date	:	03/21/2023
Last Update Date	:	03/23/2023

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