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Organization
COASTAL JAW SURGERY OF NEW PORT RICHEY, P.A.
Active
Organization
COASTAL JAW SURGERY OF NEW PORT RICHEY, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK WAYNE MITCHELL D.D.S. (PRESIDENT)
(727) 842-5180
Entity
Organization
Contact information
Practice address
2720 PARK DR, CLEARWATER, FL 33763-1020
(727) 726-8500
(727) 725-9716
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
DN10802
FL
Other
Enumeration date
11/17/2008
Last updated
11/17/2008
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