Provider Demographics
NPI:1952820607
Name:ACOSTA, LUIS GUSTAVO (DDS)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:GUSTAVO
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 1:27661 BOUQUET CANYON RD
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-1793
Mailing Address - Country:US
Mailing Address - Phone:661-347-0031
Mailing Address - Fax:
Practice Address - Street 1:27661 BOUQUET CANYON RD
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350-1793
Practice Address - Country:US
Practice Address - Phone:661-347-0031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-13
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60745075122300000X
CADDS105742122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist