Individual
JOHN A ACOSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
7734 AIRWAYS BLVD, SOUTHAVEN, MS 38671-5306
(662) 349-3838
(662) 349-5923
Mailing address
7734 AIRWAYS BLVD, SOUTHAVEN, MS 38671-5306
(662) 349-3838
(662) 349-5923
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
3118
MS
1223P0221X
Pediatric Dentistry
7024
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3153834
BCBS TN PROVIDER
TN
05
—
8088
—
TN
Enumeration date
12/29/2006
Last updated
07/08/2007
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