Massimo Costalonga, D.M.D., PH.D.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

D11846 Issued in MN

Practice address

516 Delaware St SE
7-300 PWB
Minneapolis, MN 55455-0356

Phone

(612) 626-3233

NPI assigned

May 18, 2011

Last updated

May 18, 2011By 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

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1305676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1305676800000",
    "number": "1649563040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 DELAWARE ST SE",
            "address_2": "7-368 MOOST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554550357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 DELAWARE ST SE",
            "address_2": "7-300 PWB",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554550356",
            "telephone_number": "612-626-3233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTALONGA",
        "first_name": "MASSIMO",
        "name_prefix": "Dr.",
        "credential": "D.M.D., PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-05-18",
        "last_updated": "2011-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "MN",
            "license": "D11846",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cosmo Care LLC
• Cosmo Home Healthcare Services, L.L.C.
• Cosmopolitan & Associates, Inc.
• Gail Costa, BS,LADC
• Jacquelyn Ann Costabilo, RD, LD
• Carrie Lee Costantini, M.D.
• Todd Wilson Costantini, M.D.
• Claire Alisse Costanza, PA-C
• Kelly L Costello, RD
• Megan Costello

• Periodontics in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Periodontics in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2011; 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.