Provider Demographics
NPI:1326439951
Name:COSTA, LORA (DDS)
Entity Type:Individual
Prefix:DR
First Name:LORA
Middle Name:
Last Name:COSTA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE H
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-2900
Mailing Address - Country:US
Mailing Address - Phone:707-585-8599
Mailing Address - Fax:707-585-8281
Practice Address - Street 1:1286 KIFER RD
Practice Address - Street 2:SUITE 110
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94086-5325
Practice Address - Country:US
Practice Address - Phone:408-981-0709
Practice Address - Fax:408-774-1700
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-18
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47733122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist