Active NPI
Manuel Emilio Costa, D.D.S
- General Practice Dentistry
- Hialeah, FL
National Provider Identifier
1659495307
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DN 8736
- Practice address
- 791 E 48TH St
Hialeah, FL 33013-1959 - Phone
- (305) 769-0252
- Fax
- (305) 953-0707
- NPI assigned
- Mar 19, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN 8736 | FL | Primary |
Addresses
Primary practice location
791 E 48TH St
Hialeah, FL 33013-1959
Mailing address
7110 Miami Lakes Way South
Miami Lakes, FL 33014
Phone (305) 828-1156
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 071495000 | Medicaid | FL |
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
| License | State | Type | Specialty |
|---|---|---|---|
| DN 8736 | FL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174262400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1659495307",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7110 MIAMI LAKES WAY SOUTH",
"city": "MIAMI LAKES",
"state": "FL",
"postal_code": "33014",
"telephone_number": "305-828-1156",
"fax_number": "305-953-0707"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "791 E 48TH ST",
"city": "HIALEAH",
"state": "FL",
"postal_code": "330131959",
"telephone_number": "305-769-0252",
"fax_number": "305-953-0707"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COSTA",
"first_name": "MANUEL",
"middle_name": "EMILIO",
"name_prefix": "Dr.",
"credential": "D.D.S",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "FL",
"license": "DN 8736",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "071495000",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hialeah, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.