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General NPI Number Information
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NPI Number | 1356767610
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Entity Type | Organization
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Legal Business Name | EDWIN ACOSTA DDS INC
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Dates
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Enumeration Date | 03/11/2014
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Last Update Date | 03/11/2014
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Provider Practice Location Address
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Address Line | 2560 E HIGHWAY 50 SUITE 103
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City | CLERMONT
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State | FL
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Zip | 34711-8411
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Country | US
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Telephone | 352-989-5815
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Fax | 321-400-1176
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Provider Business Mailing Address
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Address Line | 2560 E HIGHWAY 50 SUITE 103
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City | CLERMONT
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State | FL
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Zip | 34711-8411
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Country | US
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Telephone | 352-989-5815
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Fax | 321-400-1176
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDWIN ACOSTA
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Credential | DDS
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Telephone | 352-989-5815
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 19583
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License Number State | FL
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