# COASTAL JAW SURGERY OF NEW PORT RICHEY, P.A.

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

## Provider details

- **NPI number:** 1710131826
- **Authorized official:** DR. MARK WAYNE MITCHELL D.D.S. (PRESIDENT)
- **Authorized official phone:** (727) 842-5180

## Contact information

- **Practice address:** 2720 PARK DR, CLEARWATER, FL 33763-1020
- **Practice address phone:** (727) 726-8500
- **Practice address fax:** (727) 725-9716
- **Mailing address:** 6731 MADISON ST, NEW PORT RICHEY, FL 34652-1928
- **Mailing address phone:** (727) 842-5180
- **Mailing address fax:** (727) 846-0755

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | DN10802 | FL | Yes |

## Other

- **Enumeration date:** 11/17/2008
- **Last updated:** 11/17/2008