Provider Demographics
NPI:1922526680
Name:COSTA, PRISCILLA RAMOS (DDS)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:RAMOS
Last Name:COSTA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 TRACE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HOHENWALD
Mailing Address - State:TN
Mailing Address - Zip Code:38462-5143
Mailing Address - Country:US
Mailing Address - Phone:909-747-2972
Mailing Address - Fax:
Practice Address - Street 1:20 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HOHENWALD
Practice Address - State:TN
Practice Address - Zip Code:38462-1420
Practice Address - Country:US
Practice Address - Phone:931-796-7577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN123991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice