Provider Demographics
NPI:1437201712
Name:EMERALD COAST PERIODONTICS, P.A.
Entity Type:Organization
Organization Name:EMERALD COAST PERIODONTICS, P.A.
Other - Org Name:PATRICIA R. FRANCISCO, D.M.D., M.ED.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER,PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:FRANCISCO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:850-678-6485
Mailing Address - Street 1:719 BAYSHORE DR
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-2546
Mailing Address - Country:US
Mailing Address - Phone:850-678-6485
Mailing Address - Fax:850-678-5245
Practice Address - Street 1:719 BAYSHORE DR
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-2546
Practice Address - Country:US
Practice Address - Phone:850-678-6485
Practice Address - Fax:850-678-5245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00085741223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty