Provider Demographics
NPI:1003249467
Name:FIRST COAST DENTISTRY, P.A.
Entity Type:Organization
Organization Name:FIRST COAST DENTISTRY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:TOMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:904-249-3739
Mailing Address - Street 1:320 3RD ST STE A
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32266-5100
Mailing Address - Country:US
Mailing Address - Phone:904-249-3739
Mailing Address - Fax:904-249-7811
Practice Address - Street 1:320 3RD ST STE A
Practice Address - Street 2:
Practice Address - City:NEPTUNE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32266-5100
Practice Address - Country:US
Practice Address - Phone:904-249-3739
Practice Address - Fax:904-249-7811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN162251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty