Chanda J Costello, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D9133 Issued in OR

Practice address

10211 SW Park Way
Portland, OR 97225-5009

Phone

(503) 203-6978

NPI assigned

Aug 13, 2008

Last updated

Mar 5, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1218585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1488672000000",
    "number": "1235385980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10211 SW PARK WAY",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255009",
            "telephone_number": "503-203-6978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10211 SW PARK WAY",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255009",
            "telephone_number": "503-203-6978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTELLO",
        "first_name": "CHANDA",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-13",
        "last_updated": "2017-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D9133",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy Lynn Costanza-Smith, CCC-SLP
• Costco Wholesale Corporation
• Costco Wholesale Corporation (Costco Hearing Aid #2)
• Costco Wholesale Corporation (Costco Optical #2)
• Brianna Elizabeth-O'Mara Costello, PA-C
• Desiree Porter Costello
• Elizabeth Natalia Costello, RN
• Jason Richard Costello, LAC
• Mae Cecile Costello, L.AC.
• Nicole Costello

• General Practice Dentistry in Portland, OR
• Providers in Portland, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2017; 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.