Organization
ACOSTA DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VALERIE HAMILTON (DIRECTOR OF CONTRACTING)
(315) 454-6000
Entity
Organization
Contact information
Practice address
2143 W US HIGHWAY 90 STE A, LAKE CITY, FL 32055-7726
(386) 243-2031
(386) 755-0132
Mailing address
PO BOX 70887, CLEVELAND, OH 44190-0887
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
03/26/2024
Last updated
06/05/2024
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