# COASTAL ORAL MAXILLOFACIAL SURGERY & IMPLANTS, INC.

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

## Provider details

- **NPI number:** 1982973954
- **Authorized official:** DR. KEVIN DANIEL KIELY DMD (OWNER/ORAL SURGEON)
- **Authorized official phone:** (757) 207-0138

## Contact information

- **Practice address:** 5408 DISCOVERY PARK BLVD, SUITE 101, WILLIAMSBURG, VA 23188-2893
- **Practice address phone:** (757) 208-0138
- **Practice address fax:** (757) 206-1981
- **Mailing address:** 5408 DISCOVERY PARK BLVD, SUITE 101, WILLIAMSBURG, VA 23188-2893
- **Mailing address phone:** (757) 208-0138
- **Mailing address fax:** (757) 206-1981

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 0401007303 | VA | Yes |

## Other

- **Enumeration date:** 12/21/2011
- **Last updated:** 12/21/2011