Provider Demographics
NPI:1336352426
Name:ANTHONY DICOSTANZO, DDS, LTD
Entity Type:Organization
Organization Name:ANTHONY DICOSTANZO, DDS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:DICOSTANZO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-990-9009
Mailing Address - Street 1:120 OAKBROOK CTR
Mailing Address - Street 2:PROFESSIONAL BUILDING, SUITE 604
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1806
Mailing Address - Country:US
Mailing Address - Phone:630-990-9009
Mailing Address - Fax:630-990-9057
Practice Address - Street 1:120 OAKBROOK CTR
Practice Address - Street 2:PROFESSIONAL BUILDING, SUITE 604
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1806
Practice Address - Country:US
Practice Address - Phone:630-990-9009
Practice Address - Fax:630-990-9057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty