Provider Demographics
NPI:1033371174
Name:GULF COAST FAMILY DENTISTRY
Entity Type:Organization
Organization Name:GULF COAST FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:GLEEN
Authorized Official - Last Name:HART
Authorized Official - Suffix:JR
Authorized Official - Credentials:DN 16386
Authorized Official - Phone:850-944-5515
Mailing Address - Street 1:3101 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32526-1869
Mailing Address - Country:US
Mailing Address - Phone:850-944-5515
Mailing Address - Fax:850-944-0644
Practice Address - Street 1:3101 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32526-1869
Practice Address - Country:US
Practice Address - Phone:850-944-5515
Practice Address - Fax:850-944-0644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN130841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty