Provider Demographics
NPI:1013738830
Name:ROGERIO COSTA, MARCOS (DDS)
Entity type:Individual
Prefix:DR
First Name:MARCOS
Middle Name:
Last Name:ROGERIO COSTA
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 1:121 NORTH ST APT 301
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-6585
Mailing Address - Country:US
Mailing Address - Phone:403-402-2150
Mailing Address - Fax:
Practice Address - Street 1:874 PURCHASE ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-6232
Practice Address - Country:US
Practice Address - Phone:508-992-6553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1005231223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health