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General NPI Number Information
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NPI Number | 1013738830
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Entity Type | Individual
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Provider Name | MARCOS ROGERIO COSTA DDS
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Gender | Male
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Dates
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Enumeration Date | 10/23/2024
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 874 PURCHASE ST
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City | NEW BEDFORD
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State | MA
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Zip | 02740-6232
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Country | US
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Telephone | 508-992-6553
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Fax |
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Provider Business Mailing Address
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Address Line | 121 NORTH ST APT 301
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City | NEW BEDFORD
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State | MA
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Zip | 02740-6585
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Country | US
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Telephone | 403-402-2150
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | 100523
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License Number State | MA
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