DR. JOHN M COSTLEY (NPI# 1689761488) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689761488 |
| Entity Type | Individual |
| Full Name | DR. JOHN M COSTLEY |
| Other Name | DR. JOHN M COSTLEY |
| Credential | DDS |
| Practice Address |
500 Foothill Dr. Salt Lake City UT 84148 |
| Mailing Address |
1214 E. Sherwood Dr Kaysville UT 84037 |
| Practice Telephone | 8015841206 |
| Mailing Telephone | 8015460400 |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
275085-9923 | UT | Dental Providers |
| Street Address |
500 FOOTHILL DR. |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84148 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245339530 | Daniel H Priestly | Radiology | 500 Foothill Dr., Salt Lake City, UT 84148 | 2006-09-22 |
| 1689284044 | Elaine Grace Artajo Imperio | Student in an Organized Health Care Education/Training Program | 500 Foothill Dr., Salt Lake City, UT 84148 | 2020-07-31 |
| 1285267054 | Andrew M Walker | Registered Nurse | 500 Foothill Dr., Salt Lake City, UT 84148-0001 | 2020-02-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598211799 | Jacquelyn Rae Contant | Dietitian, Registered | 500 Foothill Dr. (120), Salt Lake City, UT 84148 | 2016-08-28 |
| 1699127811 | Taylor Alford | Pharmacist | 500 Foothills Drive, Salt Lake City, UT 84148 | 2016-07-12 |
| 1356792162 | Sarah Hummel | Genetic Counselor, MS | 500 Foothill Drive, Sarah Hummel, Va Salt Lake City, Genomic Medicine (10p4e), Salt Lake City - Salt Lake, UT 84148 | 2016-06-23 |
| 1174936140 | Elizabeth Shade Cardenas | Nurse Practitioner | 500 Foothill Drive #182h, Veterans Healthcare Administration, Salt Lake City, UT 84148 | 2014-06-08 |
| 1386904043 | David Earl Moore | Specialist | 500 Foothill Blvd (research), George E. Wahlen Va Healthcare System, Salt Lake City, UT 84148 | 2012-05-29 |
| 1790059038 | Deborah Ernstein Holley Hartzfeld | Genetic Counselor, MS | 615 Arapeen Drive #212, Salt Lake City, UT 84148 | 2012-03-05 |
| 1073823720 | Diana Lynn Robbins | Social Worker | 9140 W. Post Road, Las Vegas, NV 84148 | 2010-10-15 |
| 1659534394 | Katherine Margaret Dunn | Genetic Counselor, MS | 500 Foothill Drive (151z), Salt Lake City, UT 84148 | 2008-07-02 |
| 1730381625 | Douglas James Ball | Medical Genetics | Va Salt Lake City Health Care System 10p11, Salt Lake City, UT 84148 | 2007-06-03 |
| 1942234570 | David Dean Bishop | Pharmacist | 500 Foothill Blvd., Salt Lake City, UT 84148 | 2006-07-10 |
| Find all providers in zip 84148 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881982585 | Lloyd V Tilt | Dentist | 1316 Harvard Ave, Salt Lake City, UT 84105-1916 | 2011-07-14 |
| 1780840884 | Larisse Skene | Dentist | 1955 S 13th E, Suite 3, Salt Lake City, UT 84105-3638 | 2008-07-29 |
| 1659536225 | Jeremy Dwight Manwaring | Dentist | 6287 S. Redwood Road, Suite#102, Salt Lake City, UT 84123 | 2008-07-23 |
| 1962615948 | Daniel Heiner Thunell | Dentist | 4252 South Highland Dr., Salt Lake City, UT 84124 | 2007-05-07 |
| 1558487827 | Redwood Periodontics, LLC | Dentist | 6287 S Redwood Rd Ste 102, Salt Lake City, UT 84123-6653 | 2007-03-21 |
| 1851439251 | Mark Legrand Mangelson | Dentist | 4010 S 700 E Ste 8, Salt Lake City, UT 84107-2573 | 2007-02-01 |
| 1750432449 | Jon D Manwaring | Dentist | 7138 So Highland Dr, #109, Salt Lake City, UT 84121 | 2007-01-16 |
| 1114014784 | Christian Andre Nielsen | Dentist | 1955 S 1300 E Ste 3, Salt Lake City, UT 84105-3683 | 2006-10-06 |
| 1922664556 | Salt Lake Implants and Periodontics | Dentist | 4010 S 700 E Ste 8, Salt Lake City, UT 84107-2582 | 2019-05-20 |
| 1073059267 | Kenneth Gene Bills | Dentist | 2180 E 4500 S, Suite 240, Salt Lake City, UT 84117 | 2017-01-11 |
| Find all providers in SALT LAKE CITY | ||||
| City | SALT LAKE CITY |
| Zip Code | 84148 |
Please comment or provide details below to improve the information on DR. JOHN M COSTLEY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.