Organization
RAFAEL ACOSTA, DDS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAFAEL A. ACOSTA DDS (SOLE PROPRIETOR)
(240) 215-1138
Entity
Organization
Contact information
Practice address
110 BAUGHMANS LN, SUITE 140, FREDERICK, MD 21702-4059
(240) 215-1138
(240) 215-1140
Mailing address
PO BOX 1149, FREDERICK, MD 21702-0149
(240) 215-1138
(240) 215-1140
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12408
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12408
STATE LICENSE
MD
Enumeration date
09/05/2011
Last updated
09/05/2011
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