| Coast Florida P.a. | |
|
23036 State Road 54 Ste 403 Lutz FL 33549-6968 | |
| (813) 909-1317 | |
| (813) 949-1630 |
| Full Name | Coast Florida P.a. |
|---|---|
| Speciality | Dentist |
| Location | 23036 State Road 54 Ste 403, Lutz, Florida |
| Authorized Official Name and Position | Melody Rivera (CREDENTIALING MANAGER) |
| Authorized Official Contact | 8133507166 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Coast Florida P.a. 5706 Benjamin Center Dr Ste 103 Tampa FL 33634-5262 Ph: (813) 288-1999 | Coast Florida P.a. 23036 State Road 54 Ste 403 Lutz FL 33549-6968 Ph: (813) 909-1317 |
| NPI Number | 1740856129 |
|---|---|
| Provider Enumeration Date | 05/27/2021 |
| Last Update Date | 05/27/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740856129 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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