Thiago Santos Costa, DDS
Individual provider Active NPI Dentist · Overland Park, KS
NPI 1053929646 · NPPES record last updated Jul 20, 2020
Key facts
- NPI
- 1053929646
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 61647 (KS)
- Practice address
- 9528 Antioch Rd
Overland Park, KS 66212-4058 - Phone
- (913) 286-5189
- NPI assigned
- Jul 20, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 61647 | KS | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Brookridge Dentistry, PA | Dentist | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 61647 | KS | Yes |
Addresses
Primary practice location
9528 Antioch Rd
Overland Park, KS 66212-4058
Mailing address
9259 W 121St PL Apt 121
Overland Park, KS 66213-2548
Phone (919) 434-1908
Other providers in Overland Park, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 20, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.