Healthcare Provider Details

I. General information

NPI: 1013738830
Provider Name (Legal Business Name): MARCOS ROGERIO COSTA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2024
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

874 PURCHASE ST
NEW BEDFORD MA
02740-6232
US

IV. Provider business mailing address

121 NORTH ST APT 301
NEW BEDFORD MA
02740-6585
US

V. Phone/Fax

Practice location:
  • Phone: 508-992-6553
  • Fax:
Mailing address:
  • Phone: 403-402-2150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number100523
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: