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Organization
COASTAL PEDIATRIC DENTISTRY, LLC
Active
Organization
COASTAL PEDIATRIC DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWARD VICTOR BROWN III DDS, MSD (OWNER)
(504) 237-1203
Entity
Organization
Contact information
Practice address
1119 42ND AVE, GULFPORT, MS 39501-2664
(228) 864-8521
Mailing address
1119 42ND AVE, GULFPORT, MS 39501-2664
(228) 864-8521
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
3502-09
MS
Other
Enumeration date
12/02/2016
Last updated
12/02/2016
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