DR. Shane Ryan Costa, D.D.S

NPI #1407889306 in Reston, Virginia

Provider Information

NPI Number
1407889306
Entity Type
Individual
Name
DR. Shane Ryan Costa, D.D.S
Gender
Not Specified
Sole Proprietor
Yes
Primary Specialty
Dentist - General Practice
Credential
D.D.S
Enumeration Date
Jul 7, 2006
Last Updated
Jul 8, 2007

Practice Location

Address
1950 ROLAND CLARKE PL
Address 2
SUITE 450
City
Reston
ZIP Code
20191-1414
Phone
(703) 391-2600

Specialties & Taxonomy Codes

Specialty
Dentist - General PracticeGeneral Practice

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