Provider Demographics
NPI:1093693590
Name:COASTAL PEDIATRIC DENTISTRY LLC
Entity type:Organization
Organization Name:COASTAL PEDIATRIC DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:H
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:912-756-5437
Mailing Address - Street 1:1101 GANDY DANCER
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-8897
Mailing Address - Country:US
Mailing Address - Phone:912-756-5437
Mailing Address - Fax:
Practice Address - Street 1:1101 GANDY DANCER
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-8897
Practice Address - Country:US
Practice Address - Phone:912-756-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty