Organization
COASTAL DENTAL CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY N PENNINGTON D.M.D. (DOCTOR)
(912) 882-9602
Entity
Organization
Contact information
Practice address
368 CHARLIE SMITH SR HWY, SAINT MARYS, GA 31558-3101
(912) 882-9602
(912) 882-7564
Mailing address
368 CHARLIE SMITH SR HWY, SAINT MARYS, GA 31558-3101
(912) 882-9602
(912) 882-7564
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1646968
UNITED CONCORDIA
PA
Enumeration date
06/13/2007
Last updated
08/22/2020
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