Provider Demographics
NPI:1962614537
Name:COSTIGAN, MARY F (DMD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:F
Last Name:COSTIGAN
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 1:2 FORGE GATE DRIVE
Mailing Address - Street 2:UNIT H-8
Mailing Address - City:COLD SPRING
Mailing Address - State:NY
Mailing Address - Zip Code:10516
Mailing Address - Country:US
Mailing Address - Phone:845-265-3087
Mailing Address - Fax:
Practice Address - Street 1:523 ROUTE 303
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:NY
Practice Address - Zip Code:10962
Practice Address - Country:US
Practice Address - Phone:845-359-0407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049520-11223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics