Provider Demographics
NPI:1063173011
Name:COSTELLO, DARREN PATRICK (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:DARREN
Middle Name:PATRICK
Last Name:COSTELLO
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 ROWLEY RD
Mailing Address - Street 2:
Mailing Address - City:BOXFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01921-1838
Mailing Address - Country:US
Mailing Address - Phone:978-912-1158
Mailing Address - Fax:
Practice Address - Street 1:40 SALEM ST
Practice Address - Street 2:
Practice Address - City:LYNNFIELD
Practice Address - State:MA
Practice Address - Zip Code:01940-2673
Practice Address - Country:US
Practice Address - Phone:781-245-7986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18592691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice