| Coastal Jaw Surgery Of New Port Richey, P.a. | |
|
2720 Park Dr Clearwater FL 33763-1020 | |
| (727) 726-8500 | |
| (727) 725-9716 |
| Full Name | Coastal Jaw Surgery Of New Port Richey, P.a. |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 2720 Park Dr, Clearwater, Florida |
| Authorized Official Name and Position | Mark Wayne Mitchell (PRESIDENT) |
| Authorized Official Contact | 7278425180 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastal Jaw Surgery Of New Port Richey, P.a. 6731 Madison St New Port Richey FL 34652-1928 Ph: (727) 842-5180 | Coastal Jaw Surgery Of New Port Richey, P.a. 2720 Park Dr Clearwater FL 33763-1020 Ph: (727) 726-8500 |
| NPI Number | 1710131826 |
|---|---|
| Provider Enumeration Date | 11/17/2008 |
| Last Update Date | 11/17/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710131826 | NPI | - | NPPES |
| 072932900 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | DN10802 (Florida) | Primary |
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