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General NPI Number Information
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NPI Number | 1316317530
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Entity Type | Organization
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Legal Business Name | TAIDY COSTOYA DMD PLLC
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Dates
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Enumeration Date | 09/30/2015
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Last Update Date | 05/24/2024
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Provider Practice Location Address
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Address Line | 8181 SW 117TH ST
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City | PINECREST
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State | FL
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Zip | 33156-4448
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Country | US
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Telephone | 305-235-0020
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Fax | 305-971-7670
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Provider Business Mailing Address
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Address Line | 8181 SW 117TH ST
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City | PINECREST
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State | FL
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Zip | 33156-4448
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Country | US
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Telephone | 305-235-0020
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Fax | 305-971-7670
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Authorized Official
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Title or Position | MANAGING MEMBER/ OWNER
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Name | DR. TAIDY COSTOYA
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Credential | DMD
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Telephone | 305-235-0020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN17603
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License Number State | FL
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