Provider Demographics
NPI:1528388857
Name:ACOSTA, VICTOR HUGO (DDS)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:HUGO
Last Name:ACOSTA
Suffix:
Gender:M
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:PO BOX 2152
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21203-2152
Mailing Address - Country:US
Mailing Address - Phone:410-558-2222
Mailing Address - Fax:410-558-0370
Practice Address - Street 1:250 S BROADWAY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231-2405
Practice Address - Country:US
Practice Address - Phone:410-558-2222
Practice Address - Fax:410-558-0370
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13131122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist