Miriam R Acosta, DDS

Individual provider Active NPI General Practice Dentistry · Cupertino, CA

NPI 1154447746 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1154447746
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Dentistry 1223G0001X
License
35585 (CA)
Practice address
19286 Stevens Creek Blvd
Cupertino, CA 95014-2504
Phone
(408) 253-2296
Fax
(408) 873-1215
NPI assigned
Mar 22, 2007
Sex
Female
Sole proprietor
Yes

Medicare participation

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

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
35585CAMDGeneral Practice Dentistry

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 35585 CA Yes

Addresses

Primary practice location

19286 Stevens Creek Blvd
Cupertino, CA 95014-2504

Mailing address

21085 Lauretta Dr
Cupertino, CA 95014-1655
Phone (408) 253-2296

Other providers in Cupertino, CA

All providers in Cupertino, CA · General Practice Dentistry in California

Sources for this page

Verify at the official NPI Registry.