Taidy Costoya, D.M.D
Individual provider Active NPI Prosthodontics · Pinecrest, FL
NPI 1497088835 · NPPES record last updated May 24, 2024
Key facts
- NPI
- 1497088835
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Prosthodontics 1223P0700X
- License
- DN 17603 (FL)
- Practice address
- 8181 SW 117TH St
Pinecrest, FL 33156-4448 - Phone
- (305) 235-0020
- Fax
- (305) 971-7670
- NPI assigned
- Sep 17, 2009
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160623001004 | FL | Order and Referring Only - Oral Surgery |
4284925140 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN 17603 | FL | MD | Prosthodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Taidy Costoya DMD PLLC | Current |
Accepting new patients |
Locations
8181 SW 117th St
Pinecrest, FL 33156
Phone (305) 235-0020
11507 S Dixie Hwy
Pinecrest, FL 33156
Phone (305) 235-0020
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | DN 17603 | FL | Yes |
Addresses
Primary practice location
8181 SW 117TH St
Pinecrest, FL 33156-4448
Mailing address
8181 SW 117TH St
Pinecrest, FL 33156-4448
Phone (305) 235-0020
Other providers in Pinecrest, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 24, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.