Provider Demographics
NPI:1679644116
Name:COSTIGAN, SUN H (DDS)
Entity type:Individual
Prefix:DR
First Name:SUN
Middle Name:H
Last Name:COSTIGAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 SAN MARIN DR
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-1254
Mailing Address - Country:US
Mailing Address - Phone:415-209-6060
Mailing Address - Fax:
Practice Address - Street 1:197 SAN MARIN DR
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-1254
Practice Address - Country:US
Practice Address - Phone:415-209-6060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44664122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist