Organization
COASTAL PEDIATRIC DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWARD VICTOR BROWN III DDS, MSD (OWNER)
(504) 237-1203
Entity
Organization
Contact information
Practice address
1119 42ND AVE, GULFPORT, MS 39501-2664
(228) 864-8521
Mailing address
1119 42ND AVE, GULFPORT, MS 39501-2664
(228) 864-8521
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
3502-09
MS
Other
Enumeration date
12/02/2016
Last updated
12/02/2016
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