Healthcare Provider Details

I. General information

NPI: 1609801141
Provider Name (Legal Business Name): LIMITED TO ENDODONTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 S. WESTMONTE DR. SUITE 2070
ALTAMONTE SPRINGS FL
32714
US

IV. Provider business mailing address

225 S. WESTMONTE DR. SUITE 2070
ALTAMONTE SPRINGS FL
32714
US

V. Phone/Fax

Practice location:
  • Phone: 407-682-6474
  • Fax: 407-682-0901
Mailing address:
  • Phone: 407-682-6474
  • Fax: 407-682-0901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSE F. COSTAS
Title or Position: OWNER/PRESIDENT
Credential: D.M.D., M.S.
Phone: 407-682-6474