Organization
DR. SHANE COSTA/LITTLE SMILES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHANE R COSTA D.D.S. (DOCTOR/OWNER)
(703) 757-0833
Entity
Organization
Contact information
Practice address
42395 RYAN RD, SUITE 104, ASHBURN, VA 20148-4863
(703) 757-0833
(703) 757-0833
Mailing address
42395 RYAN RD, SUITE 104, ASHBURN, VA 20148-4863
(703) 757-0833
(703) 757-0833
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401410911
VA
Other
Enumeration date
06/11/2013
Last updated
06/11/2013
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