# COASTAL DENTAL GROUP SOUTH LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205202850
- **Authorized official:** DR. JOSEPH RICHARD ZICCHINO D.D.S. (OWNER/DENTIST)
- **Authorized official phone:** (732) 714-1030

## Contact information

- **Practice address:** 2407 BRIDGE AVE, POINT PLEASANT BORO, NJ 08742-4334
- **Practice address phone:** (732) 714-1030
- **Mailing address:** 2407 BRIDGE AVE, POINT PLEASANT BORO, NJ 08742-4334
- **Mailing address phone:** (732) 714-1030
- **Mailing address fax:** (732) 714-1142

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 22DI02008701 | NJ | Yes |

## Other

- **Enumeration date:** 08/18/2015
- **Last updated:** 08/18/2015