Individual
DR. PERCIVAL FREDERICK DACOSTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2234 SALEM AVE, DAYTON, OH 45406-5627
(937) 278-0891
(937) 278-5179
Mailing address
2234 SALEM AVE, DAYTON, OH 45406-5627
(937) 278-0891
(937) 278-5179
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
30. 015929
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0371511
—
OH
Enumeration date
05/08/2007
Last updated
07/09/2007
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