Provider Demographics
NPI:1023539699
Name:DA COSTA, WALMIR BALDOCCHI (DMD)
Entity Type:Individual
Prefix:DR
First Name:WALMIR
Middle Name:BALDOCCHI
Last Name:DA COSTA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 E ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-4343
Mailing Address - Country:US
Mailing Address - Phone:352-333-0070
Mailing Address - Fax:
Practice Address - Street 1:1340 E ORANGE AVE
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-4343
Practice Address - Country:US
Practice Address - Phone:352-273-5440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-04
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN225821223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry