Provider Demographics
NPI:1790708865
Name:ACOSTA, ENRIQUE (DDS)
Entity Type:Individual
Prefix:MR
First Name:ENRIQUE
Middle Name:
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 1:8351 WEST ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071
Mailing Address - Country:US
Mailing Address - Phone:954-341-0002
Mailing Address - Fax:954-341-7272
Practice Address - Street 1:8351 W ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-7454
Practice Address - Country:US
Practice Address - Phone:954-341-0002
Practice Address - Fax:954-341-7272
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN172841223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL076110900Medicaid