Provider Demographics
NPI:1407230113
Name:DICOSTANZO, GABRIEL T (DMD)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:T
Last Name:DICOSTANZO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1323 BEAR RUN DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-1496
Mailing Address - Country:US
Mailing Address - Phone:412-370-3008
Mailing Address - Fax:
Practice Address - Street 1:1323 BEAR RUN DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-1496
Practice Address - Country:US
Practice Address - Phone:412-370-3008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040495122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist