Provider Demographics
NPI:1740995430
Name:COASTAL DENTURES & IMPLANTS
Entity type:Organization
Organization Name:COASTAL DENTURES & IMPLANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:228-342-6225
Mailing Address - Street 1:4010 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28504-7906
Mailing Address - Country:US
Mailing Address - Phone:252-208-4430
Mailing Address - Fax:
Practice Address - Street 1:6213 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-2664
Practice Address - Country:US
Practice Address - Phone:228-215-0801
Practice Address - Fax:228-367-0007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-18
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty