Coastal Craniofacial, LLC

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

Legal business name

COASTAL CRANIOFACIAL, LLC

Practice address

1100 Airport Blvd Ste a
Pensacola, FL 32504-8622

Phone

(850) 477-7715

Fax

(850) 474-4823

NPI assigned

Feb 28, 2018

Organization subpart

No

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

Authorized official

Name

Aaron Wallender, MD

Title

President/Owner

Phone

(850) 477-7715

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• James Clay Sims, D.M.D

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Pensacola, FL
  • NPI 1700190717
  NPD (past)

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

{
    "created_epoch": "1519776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519776000000",
    "number": "1215438817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 AIRPORT BLVD STE A",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325048622",
            "telephone_number": "850-477-7715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 AIRPORT BLVD STE A",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325048622",
            "telephone_number": "850-477-7715",
            "fax_number": "850-474-4823"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL CRANIOFACIAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-28",
        "last_updated": "2018-02-28",
        "status": "A",
        "authorized_official_last_name": "WALLENDER",
        "authorized_official_first_name": "AARON",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "850-477-7715",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clinical Psychology Services, LLC
• Daniel P Cloutier, BS
• Roger C Clubbs, MD
• CMS Pensacola
• Coastal Cosmetic Family Dentistry
• Coastal Nursecare of Florida, Inc.
• Coastal Oxygen & Medical Supply, LLC
• Coastal Sunshine and Reign
• Coastal Sunshine and Reign
• Coastal Vascular and Interventional PLLC

• Oral & Maxillofacial Surgery (D.M.D.) in Pensacola, FL
• Providers in Pensacola, FL by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2018; 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.