Individual
MRS. STACEY LYNNE COSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
2084 NE PROFESSIONAL CT, BEND, OR 97701-6077
(541) 383-3005
Mailing address
18866 SHOSHONE RD, BEND, OR 97702-7923
(530) 526-2415
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
23431
CA
124Q00000X
Dental Hygienist
Primary
H7792
OR
Other
Enumeration date
03/17/2008
Last updated
02/27/2025
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