# DR. SHANE COSTA/LITTLE SMILES

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

## Provider details

- **NPI number:** 1649618711
- **Authorized official:** DR. SHANE R COSTA D.D.S. (DOCTOR/OWNER)
- **Authorized official phone:** (703) 757-0833

## Contact information

- **Practice address:** 42395 RYAN RD, SUITE 104, ASHBURN, VA 20148-4863
- **Practice address phone:** (703) 757-0833
- **Practice address fax:** (703) 757-0833
- **Mailing address:** 42395 RYAN RD, SUITE 104, ASHBURN, VA 20148-4863
- **Mailing address phone:** (703) 757-0833
- **Mailing address fax:** (703) 757-0833

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 0401410911 | VA | Yes |

## Other

- **Enumeration date:** 06/11/2013
- **Last updated:** 06/11/2013