Organization
BRUNO DA COSTA DDD,MS,PC
Active
Other names
Da Costa Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRUNO CRISTALLI DA COSTA DDS, MS (OWNER/PRESIDENT)
(503) 639-6900
Entity
Organization
Contact information
Practice address
11995 SW PACIFIC HWY, TIGARD, OR 97223-6474
(503) 639-6900
(503) 684-8167
Mailing address
11995 SW PACIFIC HWY, TIGARD, OR 97223-6474
(503) 639-6900
(503) 684-8167
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D8550
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1275532384
NPI TYPE 1
OR
Enumeration date
05/14/2008
Last updated
05/14/2008
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