Provider Demographics
NPI:1598729402
Name:USPHS - US COAST GUARD
Entity Type:Organization
Organization Name:USPHS - US COAST GUARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIAPAZ
Authorized Official - Middle Name:UGARTE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:301-295-0145
Mailing Address - Street 1:1950 HOLLYCOVE RD
Mailing Address - Street 2:PO BOX 146, BENA, VA 23018
Mailing Address - City:HAYES
Mailing Address - State:VA
Mailing Address - Zip Code:23072-3803
Mailing Address - Country:US
Mailing Address - Phone:804-642-2609
Mailing Address - Fax:
Practice Address - Street 1:YORKTOWN TRAINING CENTER, US COAST GUARD
Practice Address - Street 2:YORKTOWN BOARDWALK
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23690-5000
Practice Address - Country:US
Practice Address - Phone:757-856-2230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029465L261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental