NPIMap

Organization Active NPI

Bandon Coastal Dental, LLC

  • Clinic/Center
  • Bandon, OR
National Provider Identifier
1063756401
Registry record updated Nov 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
D9802 Issued in OR
Legal business name
BANDON COASTAL DENTAL, LLC
Practice address
1097 Baltimore Ave
Bandon, OR 97411
Phone
(541) 329-0550
NPI assigned
Nov 26, 2012
Last updated
Nov 26, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Paul Morris Pantleo, D.D.S.NPI 1124276159
Title
Owner
Phone
(541) 329-0550

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X D9802 OR Primary

Addresses

Primary practice location

1097 Baltimore Ave
Bandon, OR 97411

Mailing address

PO Box 429
1097 Baltimore Ave
Bandon, OR 97411
Phone (541) 329-0550

National Provider Directory

National Provider Directory

Locations

1097 Baltimore Ave SE
Bandon, OR 97411
Phone (541) 329-0550

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1353888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1353888000000",
    "number": "1063756401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 429",
            "address_2": "1097 BALTIMORE AVE",
            "city": "BANDON",
            "state": "OR",
            "postal_code": "97411",
            "telephone_number": "541-329-0550",
            "fax_number": "541-329-0309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1097 BALTIMORE AVE",
            "city": "BANDON",
            "state": "OR",
            "postal_code": "97411",
            "telephone_number": "541-329-0550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BANDON COASTAL DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-26",
        "last_updated": "2012-11-26",
        "status": "A",
        "authorized_official_last_name": "PANTLEO",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "MORRIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-329-0550",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "OR",
            "license": "D9802",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bandon, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.