Provider Demographics
NPI:1992509434
Name:COSTA MATUO, DENISE MAYUMI (DMD)
Entity type:Individual
Prefix:DR
First Name:DENISE MAYUMI
Middle Name:
Last Name:COSTA MATUO
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17411 PROMENADE DR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5961
Mailing Address - Country:US
Mailing Address - Phone:407-946-5694
Mailing Address - Fax:
Practice Address - Street 1:17411 PROMENADE DR
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-5961
Practice Address - Country:US
Practice Address - Phone:407-946-5694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty