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General NPI Number Information
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NPI Number | 1508046384
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Entity Type | Individual
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Provider Name | JASON DOUGLAS COSTA D.D.S
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Gender | Male
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Dates
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Enumeration Date | 11/08/2007
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 3300 E CENTRAL TEXAS EXPY 302
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City | KILLEEN
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State | TX
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Zip | 76543-5306
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Country | US
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Telephone | 254-699-6799
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Fax | 254-699-3465
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Provider Business Mailing Address
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Address Line | 3300 E CENTRAL TEXAS EXPY STE 302
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City | KILLEEN
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State | TX
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Zip | 76543-5674
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Country | US
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Telephone |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 23604
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 23604
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License Number State | TX
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