Provider Demographics
NPI:1992907471
Name:PRADA DA COSTA, ELIZABETH K (DMD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:K
Last Name:PRADA DA COSTA
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Gender:F
Credentials:DMD
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Mailing Address - Street 1:100 SPARKS VALLEY RD.
Mailing Address - Street 2:SUITE C
Mailing Address - City:SPARKS
Mailing Address - State:MD
Mailing Address - Zip Code:21152
Mailing Address - Country:US
Mailing Address - Phone:410-771-8200
Mailing Address - Fax:410-771-8201
Practice Address - Street 1:100 SPARKS VALLEY RD
Practice Address - Street 2:SUITE C
Practice Address - City:SPARKS
Practice Address - State:MD
Practice Address - Zip Code:21152-9342
Practice Address - Country:US
Practice Address - Phone:410-771-8200
Practice Address - Fax:410-771-8201
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2014-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MD153331223P0221X
MI29010206201223P0221X
PADS0369631223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry