| Dr. Shane Costa/little Smiles | |
|
42395 Ryan Rd Suite 104 Ashburn VA 20148-4863 | |
| (703) 757-0833 | |
| (703) 757-0833 |
| Full Name | Dr. Shane Costa/little Smiles |
|---|---|
| Speciality | Dentist |
| Location | 42395 Ryan Rd, Ashburn, Virginia |
| Authorized Official Name and Position | Shane R Costa (DOCTOR/OWNER) |
| Authorized Official Contact | 7037570833 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr. Shane Costa/little Smiles 42395 Ryan Rd Suite 104 Ashburn VA 20148-4863 Ph: (703) 757-0833 | Dr. Shane Costa/little Smiles 42395 Ryan Rd Suite 104 Ashburn VA 20148-4863 Ph: (703) 757-0833 |
| NPI Number | 1649618711 |
|---|---|
| Provider Enumeration Date | 06/11/2013 |
| Last Update Date | 06/11/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649618711 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 0401410911 (Virginia) | Primary |
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