Provider Demographics
NPI:1962570622
Name:ACOSTA, LUIS G (DMD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:G
Last Name:ACOSTA
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 1:2001 LEE RD STE B
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-1871
Mailing Address - Country:US
Mailing Address - Phone:407-645-4741
Mailing Address - Fax:407-645-4721
Practice Address - Street 1:2001 LEE RD STE B
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-1871
Practice Address - Country:US
Practice Address - Phone:407-645-4741
Practice Address - Fax:407-645-4721
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN148141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice