Individual
AMY NICOLE LACOSTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
12025 SW 70TH AVE, TIGARD, OR 97223-9634
(503) 765-7965
Mailing address
12705 SW TRASK ST, BEAVERTON, OR 97007-3024
(916) 532-2690
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D11898
OR
1223P0300X
Periodontics
Primary
D11898
OR
Other
Enumeration date
06/29/2022
Last updated
08/20/2025
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