Provider Demographics
NPI:1437231743
Name:KOSTLEY, LEONARD M (DMD)
Entity Type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:M
Last Name:KOSTLEY
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 1:248 ROUTE 259
Mailing Address - Street 2:
Mailing Address - City:LIGONIER
Mailing Address - State:PA
Mailing Address - Zip Code:15658
Mailing Address - Country:US
Mailing Address - Phone:724-238-3066
Mailing Address - Fax:724-238-2047
Practice Address - Street 1:201 SOUTH FAIRFIELD STREET
Practice Address - Street 2:
Practice Address - City:LIGONIER
Practice Address - State:PA
Practice Address - Zip Code:15658
Practice Address - Country:US
Practice Address - Phone:724-238-3066
Practice Address - Fax:724-238-2047
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS023492L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101603728001OtherPA DEPT OF PUBLIC WELFARE
PAK0436086OtherUNITED CONCORDIA