Provider Demographics
NPI:1467740381
Name:ACOSTA, LETICIA
Entity Type:Individual
Prefix:DR
First Name:LETICIA
Middle Name:
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2335 CORAL POINT DR
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-3812
Mailing Address - Country:US
Mailing Address - Phone:239-699-6602
Mailing Address - Fax:
Practice Address - Street 1:10484 STRINGFELLOW RD
Practice Address - Street 2:SUITE 3
Practice Address - City:ST JAMES CITY
Practice Address - State:FL
Practice Address - Zip Code:33956-3208
Practice Address - Country:US
Practice Address - Phone:239-283-1041
Practice Address - Fax:239-283-1684
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19441122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist