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 |
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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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