Coastal Pediatric Dentistry, LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

3502-09 Issued in MS

Legal business name

COASTAL PEDIATRIC DENTISTRY, LLC

Practice address

1119 42ND Ave
Gulfport, MS 39501-2664

Phone

(228) 864-8521

NPI assigned

Dec 2, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Edward Victor Brown III, DDS, MSD

Title

Owner

Phone

(504) 237-1203

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1480636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480636800000",
    "number": "1184167553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1119 42ND AVE",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395012664",
            "telephone_number": "228-864-8521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1119 42ND AVE",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395012664",
            "telephone_number": "228-864-8521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL PEDIATRIC DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-02",
        "last_updated": "2016-12-02",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "VICTOR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "504-237-1203",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DDS, MSD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MS",
            "license": "3502-09",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Coastal Family Health Center, Inc. (CFHC-Gulfport Health Center Extensioin)
• Coastal Family Health Center, Inc. (Coastal Family Health Center)
• Coastal Hair Loss Center (Denisha Williams)
• Coastal Medical Equipment LLC
• Coastal Medical Supply LLC
• Coastal Plains Home Health Agency 9a
• Coastal Rehabilitation of South Mississippi
• Coastal Ultrasound, Inc.
• Coastal Wound Specialists LLC
• Coastkids Pediatric Dentistry, PLLC

• Dental Clinic/Center in Gulfport, MS
• Providers in Gulfport, MS by specialty
• Dental Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2016; 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.