Provider Demographics
NPI:1417279217
Name:ACOSTA, HENRY (DMD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:
Last Name:ACOSTA
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 1:2016 US HIGHWAY 92 W
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33823-3921
Mailing Address - Country:US
Mailing Address - Phone:863-662-9973
Mailing Address - Fax:863-875-5736
Practice Address - Street 1:2016 US HWY 92 W
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:FL
Practice Address - Zip Code:33823-3321
Practice Address - Country:US
Practice Address - Phone:863-662-9973
Practice Address - Fax:863-875-5736
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-20
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN1663431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice