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Organization

COAST DENTAL P.A.

Active
Parent organization
COAST DENTAL P.A.
Other names
Coast Dental-Orange Park
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
410 BLANDING BLVD STE 6B, ORANGE PARK, FL 32073-5065
(904) 276-5950
(904) 276-5359
Mailing address
5706 BENJAMIN CENTER DR STE 103, TAMPA, FL 33634-5262
(813) 288-1999

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary

Other

Enumeration date
05/28/2021
Last updated
05/28/2021
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