| Shane R. Costa Dds, Pc | |
|
10135 Colvin Run Rd Suite 230 Great Falls VA 22066-1872 | |
| (804) 690-2042 | |
| Not Available |
| Full Name | Shane R. Costa Dds, Pc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 10135 Colvin Run Rd, Great Falls, Virginia |
| Authorized Official Name and Position | Shane1 Ryan Costa (OWNER) |
| Authorized Official Contact | 8046902042 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Shane R. Costa Dds, Pc 10135 Colvin Run Rd Suite 230 Great Falls VA 22066-1872 Ph: (804) 690-2042 | Shane R. Costa Dds, Pc 10135 Colvin Run Rd Suite 230 Great Falls VA 22066-1872 Ph: (804) 690-2042 |
| NPI Number | 1740476993 |
|---|---|
| Provider Enumeration Date | 09/21/2007 |
| Last Update Date | 09/21/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740476993 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 0401410911 (Virginia) | Primary |
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