Provider Demographics
NPI:1932125366
Name:COASTAL PERIODONTICS, P.C.
Entity Type:Organization
Organization Name:COASTAL PERIODONTICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:912-364-9250
Mailing Address - Street 1:2925 PLAYER ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4950
Mailing Address - Country:US
Mailing Address - Phone:912-264-9250
Mailing Address - Fax:912-265-7191
Practice Address - Street 1:2925 PLAYER ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4950
Practice Address - Country:US
Practice Address - Phone:912-264-9250
Practice Address - Fax:912-265-7191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA81131223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty