Provider Demographics
NPI:1619250644
Name:COSTON, ALEXIS RAE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:RAE
Last Name:COSTON
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 1:8151 E INDIAN BEND RD
Mailing Address - Street 2:STE. 111
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-4826
Mailing Address - Country:US
Mailing Address - Phone:480-207-5047
Mailing Address - Fax:
Practice Address - Street 1:1057 N KOLB RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-1328
Practice Address - Country:US
Practice Address - Phone:520-546-3185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2015-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60752122300000X
AZD08886122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist