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Organization
COASTAL PERIODONTICS PRACTICE
Active
Organization
COASTAL PERIODONTICS PRACTICE
Active
Other names
Coastal Periodontics
Organization subpart
No
Provider details
NPI number
Authorized official
FAITH GASKINS (DIRECTOR OF CREDENTIALING)
(972) 869-3789
Entity
Organization
Contact information
Practice address
82 BEAL PKWY SW, FORT WALTON BEACH, FL 32548-5331
(850) 862-6666
Mailing address
82 BEAL PKWY SW, FORT WALTON BEACH, FL 32548-5331
(850) 862-6666
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
Other
Enumeration date
08/26/2020
Last updated
08/26/2020
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