Provider Demographics
NPI:1942391008
Name:COAST PALM COAST PL
Entity Type:Organization
Organization Name:COAST PALM COAST PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:FINNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-350-7160
Mailing Address - Street 1:5706 BENJAMIN CENTER DR STE 103
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-5262
Mailing Address - Country:US
Mailing Address - Phone:813-350-7160
Mailing Address - Fax:813-434-2325
Practice Address - Street 1:5706 BENJAMIN CENTER DR STE 103
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634
Practice Address - Country:US
Practice Address - Phone:813-350-7160
Practice Address - Fax:813-434-2325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty