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Organization
COASTAL JAW SURGERY OF NEW PORT RICHEY PA
Active
Organization
COASTAL JAW SURGERY OF NEW PORT RICHEY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK W MITCHELL DDS (PRESIDENT)
(727) 842-5180
Entity
Organization
Contact information
Practice address
6731 MADISON ST, NEW PORT RICHEY, FL 34652-1928
(727) 842-5180
(727) 846-0755
Mailing address
6731 MADISON ST, NEW PORT RICHEY, FL 34652-1928
(727) 842-5180
(727) 846-0755
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
12/31/2007
Last updated
09/12/2008
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