Provider Demographics
NPI:1588600019
Name:LOYA-COSTABILE, FLOR D (DDS)
Entity type:Individual
Prefix:DR
First Name:FLOR
Middle Name:D
Last Name:LOYA-COSTABILE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:FLOR
Other - Middle Name:D
Other - Last Name:LOYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:154 BROADWAY ST
Mailing Address - Street 2:200
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-3718
Mailing Address - Country:US
Mailing Address - Phone:708-344-5437
Mailing Address - Fax:708-344-5437
Practice Address - Street 1:154 BROADWAY ST
Practice Address - Street 2:200
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-3718
Practice Address - Country:US
Practice Address - Phone:708-344-5437
Practice Address - Fax:708-344-5437
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223P0221XDental ProvidersDentistPediatric Dentistry