Dr. Shane Costa/Little Smiles

Primary specialty

DentistTaxonomy code 122300000X

License

0401410911 Issued in VA

Legal business name

DR. SHANE COSTA/LITTLE SMILES

Practice address

42395 Ryan Rd
Suite 104
Ashburn, VA 20148-4863

Phone

(703) 757-0833

Fax

(703) 757-0833

NPI assigned

Jun 11, 2013

Last updated

Jun 11, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Shane R Costa, D.D.S.

Title

Doctor/Owner

Phone

(703) 757-0833

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1370908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370908800000",
    "number": "1649618711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "42395 RYAN RD",
            "address_2": "SUITE 104",
            "city": "ASHBURN",
            "state": "VA",
            "postal_code": "201484863",
            "telephone_number": "703-757-0833",
            "fax_number": "703-757-0833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42395 RYAN RD",
            "address_2": "SUITE 104",
            "city": "ASHBURN",
            "state": "VA",
            "postal_code": "201484863",
            "telephone_number": "703-757-0833",
            "fax_number": "703-757-0833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. SHANE COSTA/LITTLE SMILES",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-11",
        "last_updated": "2013-06-11",
        "status": "A",
        "authorized_official_last_name": "COSTA",
        "authorized_official_first_name": "SHANE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DOCTOR/OWNER",
        "authorized_official_telephone_number": "703-757-0833",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401410911",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2013; 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.