Individual provider Active NPI

Rafaela Cristina Costa Carlos

  • General Practice Dentistry
  • Philadelphia, PA
National Provider Identifier
1093427932
Registry record updated Jul 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DS045345 Issued in PA
Practice address
1 Winding Dr Ste 105
Philadelphia, PA 19131-2907
Phone
(215) 402-2471
NPI assigned
Dec 22, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 23, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DS045345 PA Primary

Addresses

Primary practice location

1 Winding Dr Ste 105
Philadelphia, PA 19131-2907

Mailing address

353 Delmar St
Philadelphia, PA 19128-4505
Phone (917) 855-1036

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DS045345PAMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1671667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753228800000",
    "number": "1093427932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "353 DELMAR ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191284505",
            "telephone_number": "917-855-1036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 WINDING DR STE 105",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191312907",
            "telephone_number": "215-402-2471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTA CARLOS",
        "first_name": "RAFAELA",
        "middle_name": "CRISTINA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-12-22",
        "last_updated": "2025-07-23",
        "certification_date": "2025-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS045345",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.