Provider Demographics
NPI:1679971493
Name:KOSTOLOWSKA, KINGA (DMD)
Entity type:Individual
Prefix:DR
First Name:KINGA
Middle Name:
Last Name:KOSTOLOWSKA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 YORK RD
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-3419
Mailing Address - Country:US
Mailing Address - Phone:215-366-5678
Mailing Address - Fax:215-346-2672
Practice Address - Street 1:35 YORK RD
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-3419
Practice Address - Country:US
Practice Address - Phone:215-366-5678
Practice Address - Fax:215-346-2672
Is Sole Proprietor?:No
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028239L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist