Healthcare Provider Details

I. General information

NPI: 1215369673
Provider Name (Legal Business Name): ALTHEA ANN ACOSTA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2013
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 CENTER DR
GAINESVILLE FL
32610-0001
US

IV. Provider business mailing address

658 NW 120TH TER APT 316
GAINESVILLE FL
32607-0680
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-7800
  • Fax:
Mailing address:
  • Phone: 219-508-1953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberDRPM3054
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60384466
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: