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1380 W North Blvd Leesburg FL 34748-3900 | |
| (352) 326-3368 | |
| (352) 326-3829 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1380 W North Blvd, Leesburg, Florida |
| Authorized Official Name and Position | James P Costello (MEMBER) |
| Authorized Official Contact | 3524081400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1380 W North Blvd Leesburg FL 34748-3900 Ph: (352) 326-3368 | 1380 W North Blvd Leesburg FL 34748-3900 Ph: (352) 326-3368 |
| NPI Number | 1407028178 |
|---|---|
| Provider Enumeration Date | 04/02/2008 |
| Last Update Date | 04/02/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407028178 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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