Provider Demographics
NPI:1386868453
Name:KINGA KOSTOLOWSKA, D.M.D., P.C.
Entity Type:Organization
Organization Name:KINGA KOSTOLOWSKA, D.M.D., P.C.
Other - Org Name:NORTHEAST DENTAL ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KINGA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSTOLOWSKA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-634-9151
Mailing Address - Street 1:2409 E ALLEGHENY AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-4402
Mailing Address - Country:US
Mailing Address - Phone:215-634-9151
Mailing Address - Fax:215-634-7723
Practice Address - Street 1:2409 E ALLEGHENY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-4402
Practice Address - Country:US
Practice Address - Phone:215-634-9151
Practice Address - Fax:215-634-7723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028239L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty