Provider Demographics
NPI:1205803392
Name:KOSTAS, JAMES P (D M D P C)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:KOSTAS
Suffix:
Gender:M
Credentials:D M D P C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:01803-2753
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:01803-2753
Practice Address - Country:US
Practice Address - Phone:781-272-0441
Practice Address - Fax:781-221-7839
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17700MA1223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice