Active NPI
Stacey Lynne Costa, RDH
- Dental Hygienist
- Bend, OR
National Provider Identifier
1871764910
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- H7792
- Practice address
- 2084 NE Professional CT
Bend, OR 97701-6077 - Phone
- (541) 383-3005
- NPI assigned
- Mar 17, 2008
- Last updated
- Feb 27, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 23431 | CA | |
| Dental Hygienist | 124Q00000X | H7792 | OR | Primary |
Addresses
Primary practice location
2084 NE Professional CT
Bend, OR 97701-6077
Mailing address
18866 Shoshone Rd
Bend, OR 97702-7923
Phone (530) 526-2415
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 |
|---|---|---|---|
| H7792 | OR | MD | Dental Hygienist |
| 23431 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1205712000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1740614400000",
"number": "1871764910",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18866 SHOSHONE RD",
"city": "BEND",
"state": "OR",
"postal_code": "977027923",
"telephone_number": "530-526-2415"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2084 NE PROFESSIONAL CT",
"city": "BEND",
"state": "OR",
"postal_code": "977016077",
"telephone_number": "541-383-3005"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COSTA",
"first_name": "STACEY",
"middle_name": "LYNNE",
"name_prefix": "Mrs.",
"credential": "RDH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-03-17",
"last_updated": "2025-02-27",
"certification_date": "2025-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "CA",
"license": "23431",
"primary": false
},
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "OR",
"license": "H7792",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bend, OR
- John L Corso, M.D.
- Ruben Cortez, CRM
- Barbara Corum
- Daniel Thomas Cosgro, PA-C
- Gary Costa
- Costco Wholesale Corporation (Costco Hearing Aid #1696)
- Costco Wholesale Corporation (Costco Optical #1696)
- Costco Wholesale Corporation
- Costco Wholesale Corporation (Costco Pharmacy #1696)
- Jeffrey Birk Costello, PHARMD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.