MEDICARE: DR. DAMIAN ACOSTA DMD

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	DN20069	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821432162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAMIAN ACOSTA DMD

Provider Business Mailing Address
First Line	:	13757 SW 152ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33177-8125
Country	:	US
Telephone Number	:	305-251-5390
Fax Number	:	305-251-5389

Provider Business Practice Location Address
First Line	:	13757 SW 152ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33177-8125
Country	:	US
Telephone Number	:	305-251-5390
Fax Number	:	305-251-5389

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2013
Last Update Date	:	04/17/2013

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