Provider Demographics
NPI:1881905529
Name:JAMES P KOSTAS D M D PC
Entity type:Organization
Organization Name:JAMES P KOSTAS D M D PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIS
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:KOSTAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-272-0441
Mailing Address - Street 1:165 BEDFORD ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-2758
Mailing Address - Country:US
Mailing Address - Phone:781-272-0441
Mailing Address - Fax:781-221-7839
Practice Address - Street 1:165 BEDFORD ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-2758
Practice Address - Country:US
Practice Address - Phone:781-272-0441
Practice Address - Fax:781-221-7839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-28
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA177001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty