Provider Demographics
NPI:1861644163
Name:COSTA, GUIDO (DMD)
Entity Type:Individual
Prefix:
First Name:GUIDO
Middle Name:
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 1:7905 MALCOLM RD
Mailing Address - Street 2:STE#300
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-1734
Mailing Address - Country:US
Mailing Address - Phone:301-868-5500
Mailing Address - Fax:301-877-9393
Practice Address - Street 1:7905 MALCOLM RD
Practice Address - Street 2:STE#300
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1734
Practice Address - Country:US
Practice Address - Phone:301-868-5500
Practice Address - Fax:301-877-9393
Is Sole Proprietor?:No
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD128201223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics