Basic Information
| Provider Information | |||||||||
| NPI: | 1487702122 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ACOSTA | ||||||||
| FirstName: | MELANIE | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2354 COLD MEADOW WAY | ||||||||
| Address2: | |||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209066227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015984476 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2415 MUSGROVE RD | ||||||||
| Address2: | 301 | ||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209045200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019898994 | ||||||||
| FaxNumber: | 3019890021 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0221X | 13628 | MD | Y | Dental Providers | Dentist | Pediatric Dentistry |
No ID Information.