Provider Demographics
NPI:1760189567
Name:SOUTHCOAST DENTAL, PLLC
Entity Type:Organization
Organization Name:SOUTHCOAST DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:KIEHL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-203-8211
Mailing Address - Street 1:20 ROSEBROOK PL STE 2
Mailing Address - Street 2:
Mailing Address - City:WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02571-1567
Mailing Address - Country:US
Mailing Address - Phone:508-203-8211
Mailing Address - Fax:
Practice Address - Street 1:20 ROSEBROOK PL STE 2
Practice Address - Street 2:
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571-1567
Practice Address - Country:US
Practice Address - Phone:508-203-8211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty