Kostelic & Associates, PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

KOSTELIC & ASSOCIATES, PLLC

Doing business as

Clemmons Village Smiles

Practice address

2265 Lewisville Clemmons Rd Ste a
Clemmons, NC 27012-7459

Phone

(336) 577-1583

NPI assigned

Feb 28, 2024

Organization subpart

No

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

Authorized official

Name

Matthew Kostelic, DMDNPI 1972097251

Title

Owner/Manager

Phone

(336) 577-1583

Specialties & licenses 1

Addresses

Other names 1

• Clemmons Village Smiles Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Matthew Kostelic, DMD

  • General Practice Dentistry
  • Clemmons, NC
  • NPI 1972097251
  NPD Authorized official

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

{
    "created_epoch": "1709078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709596800000",
    "number": "1154187920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2265 LEWISVILLE CLEMMONS RD STE A",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270127459",
            "telephone_number": "336-577-1583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2265 LEWISVILLE CLEMMONS RD STE A",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270127459",
            "telephone_number": "336-577-1583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOSTELIC & ASSOCIATES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-28",
        "last_updated": "2024-03-05",
        "certification_date": "2024-03-05",
        "status": "A",
        "authorized_official_last_name": "KOSTELIC",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "336-577-1583",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clemmons Village Smiles",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kevin A Kizer, DDS
• Keesha Kline
• Timothy Kmen
• Lynora Lee Knott
• Stuart Allan Kossover, MD
• Matthew Kostelic, DMD
• Jacob Gray Lackey, PA-C
• Stacey M Ladd, RN
• Rachel Elizabeth Lafleur, RPH
• Chelsea Lam, PHARMD

• Dental Clinic/Center in Clemmons, NC
• Providers in Clemmons, NC by specialty
• Dental Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.