Provider Demographics
NPI:1386839439
Name:COATOAM PERIODONTAL ASSOCIATES
Entity Type:Organization
Organization Name:COATOAM PERIODONTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:COATOAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-865-6363
Mailing Address - Street 1:195 W HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2599
Mailing Address - Country:US
Mailing Address - Phone:407-865-6363
Mailing Address - Fax:407-865-5957
Practice Address - Street 1:195 W HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2599
Practice Address - Country:US
Practice Address - Phone:407-865-6363
Practice Address - Fax:407-865-5957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN008131223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty