Provider Demographics
NPI:1548362726
Name:ACOSTA, DAVID D (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:D
Last Name:ACOSTA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24599
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85285-4599
Mailing Address - Country:US
Mailing Address - Phone:480-458-8191
Mailing Address - Fax:
Practice Address - Street 1:1425 W SOUTHERN AVE
Practice Address - Street 2:#15
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-4403
Practice Address - Country:US
Practice Address - Phone:480-303-0535
Practice Address - Fax:480-303-0536
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5235122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist