Washington Ave Dental Center PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DSO36827 Issued in PA

Legal business name

WASHINGTON AVE DENTAL CENTER PC

Doing business as

Dentist on Washington

Practice address

544 Washington Ave
Phila, PA 19147

Phone

(215) 389-9889

NPI assigned

Dec 9, 2011

Last updated

Dec 9, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

William John Costello III, DMD

Title

Dentist/Owner

Phone

(215) 389-9889

Specialties & licenses 1

Addresses

Other names 1

• Dentist on Washington Doing business as

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

{
    "created_epoch": "1323388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323388800000",
    "number": "1255609848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "544 WASHINGTON AVE",
            "city": "PHILA",
            "state": "PA",
            "postal_code": "19147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "544 WASHINGTON AVE",
            "city": "PHILA",
            "state": "PA",
            "postal_code": "19147",
            "telephone_number": "215-389-9889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WASHINGTON AVE DENTAL CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-09",
        "last_updated": "2011-12-09",
        "status": "A",
        "authorized_official_last_name": "COSTELLO",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "215-389-9889",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DSO36827",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dentist on Washington",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brenna Michel Wallace, MSW
• Rachel Marie Walsh, PA-C
• Nicole Walton, RPH
• Keith L Wapner, MD
• Caron Warner, LPC
• Lenore A Wasserman Scola, LCSW
• Jamie Wasson, ATR-BC, LPC
• Denise Webb, D.P.M.
• Brent Weinerman, D.O.
• Stephen P Weinstein, PHD

• General Practice Dentistry in Phila, PA
• Providers in Phila, PA by specialty
• General Practice Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2011; 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.