Provider Demographics
NPI:1760532311
Name:COSTA, ALBERTO RAFAEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALBERTO
Middle Name:RAFAEL
Last Name:COSTA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7- I # 8
Mailing Address - Street 2:TURABO GARDENS
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-6016
Mailing Address - Country:US
Mailing Address - Phone:787-744-9168
Mailing Address - Fax:787-744-5342
Practice Address - Street 1:AVE LUIS MUNOS MARIN
Practice Address - Street 2:Y 30
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-744-9168
Practice Address - Fax:787-744-5342
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR25111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2511OtherDENTAL LIC.