Provider Demographics
NPI:1083652291
Name:COSTA, DENNIS JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:JAMES
Last Name:COSTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:2790 LAKE VISTA DR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3884
Practice Address - Country:US
Practice Address - Phone:972-459-1300
Practice Address - Fax:972-459-1382
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5160207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137791311Medicaid
TX137791309Medicaid
TX137791305Medicaid
TX8R1416OtherBLUE CROSS OF TEXAS
TX137791304Medicaid
TX137791308Medicaid
TX137791303Medicaid
TX137791301Medicaid
TX137791307Medicaid
TX137791306Medicaid
TX88270KMedicare PIN
TX8R1416OtherBLUE CROSS OF TEXAS
F69285Medicare UPIN
TX137791305Medicaid
TXTXB130548Medicare PIN