DR. SHANE RYAN COSTA (NPI# 1407889306) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407889306 |
| Entity Type | Individual |
| Full Name | DR. SHANE RYAN COSTA |
| Credential | D.D.S |
| Practice Address |
1950 Roland Clarke Pl Suite 450 Reston VA 20191-1414 |
| Mailing Address |
1626 Apricot Ct Reston VA 20190-4404 |
| Practice Telephone | 7033912600 |
| Practice Fax Number | 7033912097 |
| Mailing Telephone | 7039569097 |
| Mailing Fax Number | 7033912097 |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
0401410911 | VA | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023538113 | Shane Costa | Behavior Technician | 145 Rosemary St Ste K1, Needham Heights, MA 02494-3259 | 2017-06-21 |
| Street Address |
1950 ROLAND CLARKE PL SUITE 450 |
| City | RESTON |
| State | VA |
| Zip Code | 20191-1414 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790091577 | Richard Torrence Jones | Dentist | 1950 Roland Clarke Pl, Reston, VA 20191-1414 | 2010-08-31 |
| 1467647727 | Watt and Clark L.c. | Dentist | 1950 Roland Clarke Pl, Suite # 420, Reston, VA 20191-1414 | 2007-09-10 |
| 1790821429 | Jeffry Stephen Clark | Dentist | 1950 Roland Clarke Pl, 420, Reston, VA 20191-1414 | 2007-01-29 |
| 1689730533 | Brian Robert Clark | Dentist | 1950 Roland Clarke Pl, Reston, VA 20191-1414 | 2006-12-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275150518 | Grace Andales Soistman | Nurse Practitioner | 11160 South Lakes Dr. Reston, Va 20191, Reston, VA 20191 | 2020-07-02 |
| 1790317709 | Twenty Four/7 LLC | Private Vehicle | 11922 Winterthur Ln, 103, Reston, VA 20191 | 2020-02-07 |
| 1437626058 | Aramesh Darvishian Dds Pllc | Dentist | 12040 South Lakes Dr. Suite 200, Reston, VA 20191 | 2018-11-01 |
| 1992282693 | Ashkan Ghods | Home Health | 11760 Sunrise Valley Dr, #405, Reston, VA 20191 | 2018-07-25 |
| 1104319698 | Capital Critical Care & Informatics PC | Internal Medicine | 11890 Sunrise Valley Dr # 442, Reston, VA 20191 | 2018-06-11 |
| 1063930683 | Mackenzie Marie Evans | Specialist/Technologist | 2380 Branleigh Park Ct, Reston, VA 20191 | 2017-09-04 |
| 1073910345 | Jane L Mahan-wiegand | Dietitian, Registered | 1900 Campus Commons Drive, Suite 100, Reston, VA 20191 | 2014-12-02 |
| 1700214293 | Sonny Sunghun Kim | Dentist | 11876 Sunrise Valley Drive, 101, Reston, VA 20191 | 2013-10-22 |
| 1982036786 | Stephanie Lourdes Miller | Physician Assistant | 12040 South Lakes Drive, Suite 207, Generations Family Practice, Reston, VA 20191 | 2013-08-02 |
| 1316250988 | Thao Ngoc Vuong | Pharmacist | 1898 Winterport Cluster, Reston, VA 20191 | 2010-07-23 |
| Find all providers in zip 20191 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205495074 | Christian Keith Hart | Dentist | 1939 Roland Clarke Pl Ste 120, Reston, VA 20191-1445 | 2019-06-06 |
| 1437626058 | Aramesh Darvishian Dds Pllc | Dentist | 12040 South Lakes Dr. Suite 200, Reston, VA 20191 | 2018-11-01 |
| 1326348350 | Virgina Family and Cosmetic Dentistry Inc | Dentist | 1760 Reston Pkwy Ste 415, Reston, VA 20190-3360 | 2010-10-25 |
| 1396974804 | April Rose Kern | Dentist | 1861 Explorer St Ste A, Reston, VA 20190-5665 | 2009-07-06 |
| 1437304649 | Messina Canal Moawad Dds PC | Dentist | 1886 Metro Center Drive Suite 600, Reston, VA 20190 | 2008-12-02 |
| 1194911040 | Reston Family & Cosmetic Dentistry | Dentist | 1984 Isaac Newton Sq W Ste 100, Reston, VA 20190-5039 | 2007-09-24 |
| 1386862597 | Michael Thornton Hardin | Dentist | 11711 Bowman Green Dr, Reston, VA 20190-3501 | 2007-04-23 |
| 1730205824 | Drs. Novick, Hartz & Hall, PC | Dentist | 11325 Sunset Hills Rd, Reston, VA 20190-5205 | 2007-03-21 |
| 1043377989 | Golnaz Miamee | Dentist | 11490 Commerce Park Dr Ste 110, Reston, VA 20191-1532 | 2007-01-02 |
| 1093879280 | Sungwon Choi | Dentist | 12359 Sunrise Valley Dr Ste 250, Reston, VA 20191-3494 | 2006-12-21 |
| Find all providers in RESTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.