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MICHAEL E COSTA DDS

>> Dentist >> Dental Providers

Registrant NPI Number: 1144252529

Individual Registrant:
 MICHAEL E COSTA DDS
Gender: M
Not Sole Proprietor

Location and contact information for practice:
100 SLOCUM DR  KING COVE, AK 99612 US
Tel: 907-497-2311  Fax: 907-497-2310

Contact information for business:
3380 C ST STE 100  ANCHORAGE, AK 99503-3949 US
Tel: 907-277-1440  Fax: 907-277-1436

Registration Information:
NPI: 1144252529
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y122300000XDental Providers
Dentist
AK1382
N122300000XDental Providers
Dentist
ORD7867

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
022868OR05
FEDERAL TAX ID94309677201
ALASKA DENTAL LICENSE1382AK01
STATE LICENSED7867OR01




HEALTH CARE JOBS AK - Page 1



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