Organization
COASTAL JAW SURGERY OF NEW PORT RICHEY, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK WAYNE MITCHELL D.D.S. (PRESIDENT)
(727) 842-5180
Entity
Organization
Contact information
Practice address
2720 PARK DR, CLEARWATER, FL 33763-1020
(727) 726-8500
(727) 725-9716
Mailing address
6731 MADISON ST, NEW PORT RICHEY, FL 34652-1928
(727) 842-5180
(727) 846-0755
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DN10802
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
072932900
—
FL
Enumeration date
11/17/2008
Last updated
11/17/2008
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