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General NPI Number Information
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NPI Number | 1518699263
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Entity Type | Individual
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Provider Name | AMY NICOLE LACOSTE DMD
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Gender | Female
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Dates
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Enumeration Date | 06/29/2022
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 12025 SW 70TH AVE
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City | TIGARD
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State | OR
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Zip | 97223-9634
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Country | US
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Telephone | 503-765-7965
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Fax |
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Provider Business Mailing Address
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Address Line | 12705 SW TRASK ST
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City | BEAVERTON
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State | OR
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Zip | 97007-3024
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Country | US
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Telephone | 916-532-2690
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | D11898
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | D11898
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License Number State | OR
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