Provider Demographics
NPI:1174738363
Name:COASTAL ORAL & MAXILLOFACIAL SURGEONS, PA
Entity type:Organization
Organization Name:COASTAL ORAL & MAXILLOFACIAL SURGEONS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:FIEDLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-927-9090
Mailing Address - Street 1:199 NEW RD
Mailing Address - Street 2:CENTRAL SQUARE SUITE 32
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-2025
Mailing Address - Country:US
Mailing Address - Phone:609-927-9090
Mailing Address - Fax:609-927-9091
Practice Address - Street 1:199 NEW RD
Practice Address - Street 2:CENTRAL SQUARE SUITE 32
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-2025
Practice Address - Country:US
Practice Address - Phone:609-927-9090
Practice Address - Fax:609-927-9091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ017511174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty