Provider Demographics
NPI:1538577283
Name:LUIS G. ACOSTA, DMD, PA
Entity type:Organization
Organization Name:LUIS G. ACOSTA, DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-645-4741
Mailing Address - Street 1:2001 LEE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-1871
Mailing Address - Country:US
Mailing Address - Phone:407-645-4741
Mailing Address - Fax:407-645-4721
Practice Address - Street 1:2001 LEE RD
Practice Address - Street 2:SUITE B
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-1871
Practice Address - Country:US
Practice Address - Phone:407-645-4741
Practice Address - Fax:407-645-4721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL148141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty