Michael L Costello, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2736 Issued in WI

Practice address

1333 College Ave
Suite C
South Milwaukee, WI 53172-1150

Phone

(414) 764-6070

Fax

(414) 764-3035

NPI assigned

Jul 27, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Grant Park Dental, S.C.

  • General Practice Dentistry
  • South Milwaukee, WI
  • NPI 1578994620
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1073527222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1333 COLLEGE AVE",
            "address_2": "SUITE C",
            "city": "SOUTH MILWAUKEE",
            "state": "WI",
            "postal_code": "531721150",
            "telephone_number": "414-764-6070",
            "fax_number": "414-764-3035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1333 COLLEGE AVE",
            "address_2": "SUITE C",
            "city": "SOUTH MILWAUKEE",
            "state": "WI",
            "postal_code": "531721150",
            "telephone_number": "414-764-6070",
            "fax_number": "414-764-3035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTELLO",
        "first_name": "MICHAEL",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "2736",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38387300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• City of South Milwaukee
• City of South Milwaukee (South Milwaukee Health Department)
• Megan Mae Clement, PHARMD
• Cheron Copeland, NDTR
• Dana Correnti, PA-C
• Shauntee Marie Crawford
• Genesis Cruz
• Sindhu Daggumalli, MSPT
• Eileen Louise Dahl, PTA
• Kelly J Daily, RN BSN

• General Practice Dentistry in South Milwaukee, WI
• Providers in South Milwaukee, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.