Provider Demographics
NPI:1689299240
Name:DACOSTA, DAVID HESS (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:HESS
Last Name:DACOSTA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 561 BOX 3002
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96310-0031
Mailing Address - Country:US
Mailing Address - Phone:801-717-0863
Mailing Address - Fax:
Practice Address - Street 1:MCAS IWAKUNI
Practice Address - Street 2:BUILDING 110
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96310
Practice Address - Country:US
Practice Address - Phone:315-255-8373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116034150207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine