# COAST FLORIDA P.A.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** COAST FLORIDA P.A.
- **Other names:** Coast Dental-Poinciana
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1558937946
- **Legal business name:** COAST FLORIDA P.A.
- **Authorized official:** MELODY RIVERA (CREDENTIALING MANAGER)
- **Authorized official phone:** (813) 350-7166

## Contact information

- **Practice address:** 2907 VINELAND RD, KISSIMMEE, FL 34746-5505
- **Practice address phone:** (407) 396-1288
- **Practice address fax:** (407) 397-1032
- **Mailing address:** 5706 BENJAMIN CENTER DR STE 103, TAMPA, FL 33634-5262
- **Mailing address phone:** (813) 288-1999

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 05/27/2021
- **Last updated:** 05/27/2021