Individual
DR. MICHAEL LOUIS COSTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
62 HART BLVD, STATEN ISLAND, NY 10301-2613
(718) 442-3982
Mailing address
62 HART BLVD, STATEN ISLAND, NY 10301-2613
(718) 442-3982
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
053358-1
NY
Other
Enumeration date
03/11/2008
Last updated
08/16/2011
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