Acosta Dental, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

ACOSTA DENTAL, LLC

Practice address

2143 W US Highway 90 Ste a
Lake City, FL 32055-7726

Phone

(386) 243-2031

Fax

(386) 755-0132

NPI assigned

Mar 26, 2024

Last updated

Jun 5, 2024By 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

Valerie Hamilton

Title

Director of Contracting

Phone

(315) 454-6000

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1711411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717545600000",
    "number": "1982454310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 70887",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441900887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2143 W US HIGHWAY 90 STE A",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320557726",
            "telephone_number": "386-243-2031",
            "fax_number": "386-755-0132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACOSTA DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-26",
        "last_updated": "2024-06-05",
        "certification_date": "2024-06-05",
        "status": "A",
        "authorized_official_last_name": "HAMILTON",
        "authorized_official_first_name": "VALERIE",
        "authorized_official_title_or_position": "DIRECTOR OF CONTRACTING",
        "authorized_official_telephone_number": "315-454-6000"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "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 5, 2024; 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.