MEDICARE: ACOSTALL DENTAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1801758487
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACOSTALL DENTAL LLC

Provider Business Mailing Address
First Line	:	19592 NW 82ND PL
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-5992
Country	:	US
Telephone Number	:	786-870-2897
Fax Number	:

Provider Business Practice Location Address
First Line	:	1124 W 29TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-5019
Country	:	US
Telephone Number	:	305-885-7767
Fax Number	:	305-885-7956

Authorized Official
Title or Position	:	OWNER
Name	:	BLANCA ACOSTA HERNANDEZ
Credential	:	DDS
Telephone Number	:	786-870-2897

Provider Enumeration Date	:	12/02/2025
Last Update Date	:	12/02/2025

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Directions to “ACOSTALL DENTAL LLC ” Practice Location

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