Shane R. Costa DDS, PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0401410911 Issued in VA

Legal business name

SHANE R. COSTA DDS, PC

Practice address

10135 Colvin Run Rd
Suite 230
Great Falls, VA 22066-1872

Phone

(804) 690-2042

NPI assigned

Sep 21, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Shane1 Ryan Costa, D.D.S.

Title

Owner

Phone

(804) 690-2042

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1190332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190332800000",
    "number": "1740476993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10135 COLVIN RUN RD",
            "address_2": "SUITE 230",
            "city": "GREAT FALLS",
            "state": "VA",
            "postal_code": "220661872",
            "telephone_number": "804-690-2042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10135 COLVIN RUN RD",
            "address_2": "SUITE 230",
            "city": "GREAT FALLS",
            "state": "VA",
            "postal_code": "220661872",
            "telephone_number": "804-690-2042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHANE R. COSTA DDS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-21",
        "last_updated": "2007-09-21",
        "status": "A",
        "authorized_official_last_name": "COSTA",
        "authorized_official_first_name": "SHANE1",
        "authorized_official_middle_name": "RYAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "804-690-2042",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401410911",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sonya Safaie, PHARMD
• Christian Sandoval, RPH
• Haze Edrease Sawtari X
• Ronald Schreiber, M.D.
• Melanie Seifert, DPT
• Shameen Shrestha, PHARMD
• Sleepheart of Virginia
• Rose L Smith, LPC
• Erica Elizabeth Sok, DDS
• Spinal Atrs Institute, PLLC

• General Practice Dentistry in Great Falls, VA
• Providers in Great Falls, VA by specialty
• General Practice Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 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.

Verify at the official NPI Registry.