Provider Demographics
NPI:1053840058
Name:COSCIA, CHRISTA COLLEEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTA
Middle Name:COLLEEN
Last Name:COSCIA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 MAIN ST STE 6
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02347-3622
Mailing Address - Country:US
Mailing Address - Phone:508-923-6900
Mailing Address - Fax:
Practice Address - Street 1:54 MAIN ST STE 6
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MA
Practice Address - Zip Code:02347-3622
Practice Address - Country:US
Practice Address - Phone:508-923-6900
Practice Address - Fax:774-213-9689
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18576001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice