Individual
JORDAN DEAN DA COSTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
6871 DANIELS PKWY STE 100, FORT MYERS, FL 33912-1510
(239) 288-0537
Mailing address
17225 LOSILLAS CIR UNIT 736, FORT MYERS, FL 33913-9574
(954) 536-3058
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN27037
FL
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
06/02/2022
Last updated
05/12/2023
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