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General NPI Number Information
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NPI Number | 1801758487
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Entity Type | Organization
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Legal Business Name | ACOSTALL DENTAL LLC
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Dates
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Enumeration Date | 12/02/2025
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 1124 W 29TH ST
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City | HIALEAH
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State | FL
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Zip | 33012-5019
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Country | US
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Telephone | 305-885-7767
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Fax | 305-885-7956
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Provider Business Mailing Address
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Address Line | 19592 NW 82ND PL
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City | HIALEAH
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State | FL
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Zip | 33015-5992
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Country | US
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Telephone | 786-870-2897
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BLANCA ACOSTA HERNANDEZ
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Credential | DDS
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Telephone | 786-870-2897
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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 |
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License Number State |
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