| Coastal Pediatric Dentistry, Llc | |
|
1119 42nd Ave Gulfport MS 39501-2664 | |
| (228) 864-8521 | |
| Not Available |
| Full Name | Coastal Pediatric Dentistry, Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1119 42nd Ave, Gulfport, Mississippi |
| Authorized Official Name and Position | Edward Victor Brown (OWNER) |
| Authorized Official Contact | 5042371203 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastal Pediatric Dentistry, Llc 1119 42nd Ave Gulfport MS 39501-2664 Ph: (228) 864-8521 | Coastal Pediatric Dentistry, Llc 1119 42nd Ave Gulfport MS 39501-2664 Ph: (228) 864-8521 |
| NPI Number | 1184167553 |
|---|---|
| Provider Enumeration Date | 12/02/2016 |
| Last Update Date | 12/02/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184167553 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 3502-09 (Mississippi) | Primary |
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