Organization
COAST DENTAL P.A.
Active
Parent organization
COAST DENTAL P.A.
Other names
Coast Dental-Fleming Island
Organization subpart
Yes
Provider details
NPI number
Legal business name
COAST DENTAL P.A.
Authorized official
MELODY RIVERA (CREDENTIALING MANAGER)
(813) 350-7166
Entity
Organization
Contact information
Practice address
5000 US HIGHWAY 17 STE 4, FLEMING ISLAND, FL 32003-8237
(904) 215-7855
(904) 215-7856
Mailing address
5706 BENJAMIN CENTER DR STE 103, TAMPA, FL 33634-5262
(813) 350-7166
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
05/27/2021
Last updated
05/27/2021
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