Provider Demographics
NPI:1356850044
Name:COASTAL DENTAL SEEKONK, LLC
Entity Type:Organization
Organization Name:COASTAL DENTAL SEEKONK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:KUCHAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:773-931-2196
Mailing Address - Street 1:21 BROOK ST STE 8
Mailing Address - Street 2:
Mailing Address - City:SEEKONK
Mailing Address - State:MA
Mailing Address - Zip Code:02771-4504
Mailing Address - Country:US
Mailing Address - Phone:508-399-7073
Mailing Address - Fax:
Practice Address - Street 1:21 BROOK ST STE 8
Practice Address - Street 2:
Practice Address - City:SEEKONK
Practice Address - State:MA
Practice Address - Zip Code:02771-4504
Practice Address - Country:US
Practice Address - Phone:508-399-7073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty