Provider Demographics
NPI:1528364551
Name:ACOSTA AND RAIDER LLC
Entity Type:Organization
Organization Name:ACOSTA AND RAIDER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:RAIDER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-504-8712
Mailing Address - Street 1:888 ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-6201
Mailing Address - Country:US
Mailing Address - Phone:845-628-3700
Mailing Address - Fax:
Practice Address - Street 1:888 ROUTE 6
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-6201
Practice Address - Country:US
Practice Address - Phone:845-628-3700
Practice Address - Fax:845-628-3010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-09
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY50052961122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty