Provider Demographics
NPI:1811091283
Name:COSTA, MARTA (DDS)
Entity type:Individual
Prefix:DR
First Name:MARTA
Middle Name:
Last Name:COSTA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MARTA
Other - Middle Name:
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1565 WOODRIDGE DR SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366
Mailing Address - Country:US
Mailing Address - Phone:360-876-0550
Mailing Address - Fax:360-876-0861
Practice Address - Street 1:1565 WOODRIDGE DR SE
Practice Address - Street 2:SUITE A
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366
Practice Address - Country:US
Practice Address - Phone:360-876-0550
Practice Address - Fax:360-876-0861
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA7181122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist