Healthcare Provider Details

I. General information

NPI: 1922032366
Provider Name (Legal Business Name): JOSE F. COSTAS D.M.D., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 407-682-6474
  • Fax: 407-628-0901
Mailing address:
  • Phone: 407-682-6474
  • Fax: 407-628-0901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN12875
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: