Matthew Kostelic, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

11043 Issued in NC

Practice address

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

Phone

(336) 577-1583

NPI assigned

Jun 19, 2018

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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

• Kostelic & Associates, PLLC

  • Dental Clinic/Center
  • Clemmons, NC
  • NPI 1154187920
  NPD Authorized official

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

{
    "created_epoch": "1529366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625616000000",
    "number": "1972097251",
    "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": {
        "last_name": "KOSTELIC",
        "first_name": "MATTHEW",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-06-19",
        "last_updated": "2021-07-07",
        "certification_date": "2021-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "11043",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Keesha Kline
• Timothy Kmen
• Lynora Lee Knott
• Stuart Allan Kossover, MD
• Kostelic & Associates, PLLC
• Jacob Gray Lackey, PA-C
• Stacey M Ladd, RN
• Rachel Elizabeth Lafleur, RPH
• Chelsea Lam, PHARMD
• Heysel Lam

• General Practice Dentistry in Clemmons, NC
• Providers in Clemmons, NC by specialty
• General Practice Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2021; 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.