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Organization
SHANE R. COSTA DDS, PC
Active
Organization
SHANE R. COSTA DDS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHANE1 RYAN COSTA D.D.S. (OWNER)
(804) 690-2042
Entity
Organization
Contact information
Practice address
10135 COLVIN RUN RD, SUITE 230, GREAT FALLS, VA 22066-1872
(804) 690-2042
Mailing address
10135 COLVIN RUN RD, SUITE 230, GREAT FALLS, VA 22066-1872
(804) 690-2042
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401410911
VA
Other
Enumeration date
09/21/2007
Last updated
09/21/2007
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