NPIMap

Organization Active NPI

Costa & Dageenakis Family Dentistry PLLC

  • Dentist
  • Port Orchard, WA
National Provider Identifier
1376647743
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
9302 Issued in WA
Legal business name
COSTA & DAGEENAKIS FAMILY DENTISTRY PLLC
Practice address
1565 Woodridge Dr SE
Ste a
Port Orchard, WA 98366
Phone
(360) 876-0550
Fax
(360) 876-0861
NPI assigned
Sep 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Michelle D Richardson
Title
Treatment Coordinator
Phone
(360) 876-0550

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 7181 WA
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 9302 WA Primary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X DE00009872 WA

Addresses

Primary practice location

1565 Woodridge Dr SE
Ste a
Port Orchard, WA 98366

Mailing address

1565 Woodridge Dr SE
Ste a
Port Orchard, WA 98366
Phone (360) 876-0550

National Provider Directory

National Provider Directory

Locations

1565 Woodridge Dr SE
#A
Port Orchard, WA 98366
Phone (360) 876-0550

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1376647743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1565 WOODRIDGE DR SE",
            "address_2": "STE A",
            "city": "PORT ORCHARD",
            "state": "WA",
            "postal_code": "98366",
            "telephone_number": "360-876-0550",
            "fax_number": "360-876-0861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1565 WOODRIDGE DR SE",
            "address_2": "STE A",
            "city": "PORT ORCHARD",
            "state": "WA",
            "postal_code": "98366",
            "telephone_number": "360-876-0550",
            "fax_number": "360-876-0861"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COSTA & DAGEENAKIS FAMILY DENTISTRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RICHARDSON",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "TREATMENT COORDINATOR",
        "authorized_official_telephone_number": "360-876-0550",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "WA",
            "license": "7181",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "WA",
            "license": "9302",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE00009872",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Orchard, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.