Provider Demographics
NPI:1871622266
Name:LOUIS S. D'AGOSTA, DDS, INC.
Entity type:Organization
Organization Name:LOUIS S. D'AGOSTA, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:SALVATORE
Authorized Official - Last Name:D'AGOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-248-7048
Mailing Address - Street 1:255 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-6503
Mailing Address - Country:US
Mailing Address - Phone:408-248-7048
Mailing Address - Fax:408-248-7049
Practice Address - Street 1:255 CRESTVIEW DR
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-6503
Practice Address - Country:US
Practice Address - Phone:408-248-7048
Practice Address - Fax:408-248-7049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA227941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty