Provider Demographics
NPI:1528246121
Name:COSTA, JOAO A (DMD)
Entity type:Individual
Prefix:
First Name:JOAO
Middle Name:A
Last Name:COSTA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 ROUTE 137
Mailing Address - Street 2:
Mailing Address - City:EAST HARWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02645-2177
Mailing Address - Country:US
Mailing Address - Phone:508-432-8686
Mailing Address - Fax:
Practice Address - Street 1:35 JENNIFER LN
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-2400
Practice Address - Country:US
Practice Address - Phone:508-762-8679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL1005641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice