# COSTA & DAGEENAKIS FAMILY DENTISTRY PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376647743
- **Authorized official:** MRS. MICHELLE D RICHARDSON (TREATMENT COORDINATOR)
- **Authorized official phone:** (360) 876-0550

## Contact information

- **Practice address:** 1565 WOODRIDGE DR SE, STE A, PORT ORCHARD, WA 98366
- **Practice address phone:** (360) 876-0550
- **Practice address fax:** (360) 876-0861
- **Mailing address:** 1565 WOODRIDGE DR SE, STE A, PORT ORCHARD, WA 98366
- **Mailing address phone:** (360) 876-0550
- **Mailing address fax:** (360) 876-0861

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 7181 | WA | — |
| 122300000X | Dentist | 9302 | WA | Yes |
| 122300000X | Dentist | DE00009872 | WA | — |

## Other

- **Enumeration date:** 09/07/2006
- **Last updated:** 08/22/2020