Organization
SHANE R. COSTA DDS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHANE1 RYAN COSTA D.D.S. (OWNER)
(804) 690-2042
Entity
Organization
Contact information
Practice address
10135 COLVIN RUN RD, SUITE 230, GREAT FALLS, VA 22066-1872
(804) 690-2042
Mailing address
10135 COLVIN RUN RD, SUITE 230, GREAT FALLS, VA 22066-1872
(804) 690-2042
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401410911
VA
Other
Enumeration date
09/21/2007
Last updated
09/21/2007
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