Provider Demographics
NPI:1922032366
Name:COSTAS, JOSE F (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:F
Last Name:COSTAS
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:225 S. WESTMONTE DRIVE
Mailing Address - Street 2:SUITE 2070
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714
Mailing Address - Country:US
Mailing Address - Phone:407-682-6474
Mailing Address - Fax:407-628-0901
Practice Address - Street 1:225 S. WESTMONTE DRIVE
Practice Address - Street 2:SUITE 2070
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714
Practice Address - Country:US
Practice Address - Phone:407-682-6474
Practice Address - Fax:407-628-0901
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN128751223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics