Provider Demographics
NPI:1215369673
Name:ACOSTA, ALTHEA ANN (DDS)
Entity type:Individual
Prefix:
First Name:ALTHEA
Middle Name:ANN
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 DOCK ST UNIT 210
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-3220
Mailing Address - Country:US
Mailing Address - Phone:219-508-1953
Mailing Address - Fax:
Practice Address - Street 1:703 LILLY RD NE STE 201
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5256
Practice Address - Country:US
Practice Address - Phone:360-459-3400
Practice Address - Fax:360-459-9700
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60384466122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist