Organization
COAST FLORIDA P.A.
Active
Parent organization
COAST FLORIDA P.A.
Other names
Coast Dental-Lake Mary
Organization subpart
Yes
Provider details
NPI number
Legal business name
COAST FLORIDA P.A.
Authorized official
MELODY RIVERA (CREDENTIALING MANAGER)
(813) 350-7166
Entity
Organization
Contact information
Practice address
2500 W LAKE MARY BLVD STE 106, LAKE MARY, FL 32746-3501
(407) 328-6411
(407) 328-6444
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
05/27/2021
Last updated
05/27/2021
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