Individual
MICHAEL E COSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
100 SLOCUM DR, KING COVE, AK 99612
(907) 497-2311
(907) 497-2310
Mailing address
3380 C ST STE 100, ANCHORAGE, AK 99503-3949
(907) 277-1440
(907) 277-1436
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1382
AK
122300000X
Dentist
D7867
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022868
—
OR
01
—
1382
ALASKA DENTAL LICENSE
AK
01
—
943096772
FEDERAL TAX ID
—
01
—
D7867
STATE LICENSE
OR
Enumeration date
07/07/2006
Last updated
11/23/2011
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