Provider Demographics
NPI:1942447396
Name:ACOSTA DENTAL SERVICES OF LAUDERHILL P.A
Entity Type:Organization
Organization Name:ACOSTA DENTAL SERVICES OF LAUDERHILL P.A
Other - Org Name:SUNSHINE DENTAL CENTER OF LAUDERHILL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:
Authorized Official - Last Name:ACOSTA-ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-486-6989
Mailing Address - Street 1:2331 N STATE ROAD 7
Mailing Address - Street 2:SUITE 109
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33313-3748
Mailing Address - Country:US
Mailing Address - Phone:954-486-6989
Mailing Address - Fax:954-486-6992
Practice Address - Street 1:2331 N STATE ROAD 7
Practice Address - Street 2:SUITE 109
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-3748
Practice Address - Country:US
Practice Address - Phone:954-486-6989
Practice Address - Fax:954-486-6992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty