Provider Demographics
NPI:1043941644
Name:COAST HARBOUR DENTAL AND HEALTH ASSOCIATES
Entity Type:Organization
Organization Name:COAST HARBOUR DENTAL AND HEALTH ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PERKS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-422-2599
Mailing Address - Street 1:2200 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33980-5759
Mailing Address - Country:US
Mailing Address - Phone:941-866-8011
Mailing Address - Fax:941-866-8013
Practice Address - Street 1:2200 KINGS HWY
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-5759
Practice Address - Country:US
Practice Address - Phone:941-866-8011
Practice Address - Fax:941-866-8013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty