Provider Demographics
NPI:1841585981
Name:COSTELLO, ERNEST L (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:L
Last Name:COSTELLO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 N ARLINGTON HEIGHTS RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-3985
Mailing Address - Country:US
Mailing Address - Phone:847-259-1111
Mailing Address - Fax:847-259-2222
Practice Address - Street 1:1640 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:SUITE 201
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-3985
Practice Address - Country:US
Practice Address - Phone:847-259-1111
Practice Address - Fax:847-259-2222
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028668122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist