NPIMap

Organization Active NPI

Coast Florida PA

  • Dentist
  • Melbourne, FL
National Provider Identifier
1275109258
Registry record updated Jun 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
COAST FLORIDA PA
Practice address
7777 N Wickham Rd Ste 4
Melbourne, FL 32940-7978
Phone
(321) 255-6303
Fax
(321) 255-6710
NPI assigned
Jun 1, 2021
Organization subpart
Yes
Parent organization
COAST FLORIDA PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 1, 2021

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

Authorized official

Name
Melody Rivera
Title
Credentialing Manager
Phone
(813) 350-7166

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

7777 N Wickham Rd Ste 4
Melbourne, FL 32940-7978

Mailing address

5706 Benjamin Center Dr Ste 103
Tampa, FL 33634-5262
Phone (813) 288-1999

Other names 1

  • Coast Dental-Melbourne Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Coast Florida PA47 organizations share this tax ID, including this one
Part of
Coast Florida PA

Other organizations with this tax ID 46

Organizations that report the same tax identification number in the National Provider Directory.

View all 46

Locations

7777 N Wickham Rd
Ste 4
Melbourne, FL 32940
Phone (321) 255-6303

Practitioners & affiliated clinicians

Practitioners 10

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

NPI Registry JSON

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

{
    "created_epoch": "1622505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622505600000",
    "number": "1275109258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5706 BENJAMIN CENTER DR STE 103",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336345262",
            "telephone_number": "813-288-1999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7777 N WICKHAM RD STE 4",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329407978",
            "telephone_number": "321-255-6303",
            "fax_number": "321-255-6710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COAST FLORIDA PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COAST FLORIDA PA",
        "enumeration_date": "2021-06-01",
        "last_updated": "2021-06-01",
        "certification_date": "2021-06-01",
        "status": "A",
        "authorized_official_last_name": "RIVERA",
        "authorized_official_first_name": "MELODY",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "813-350-7166"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coast Dental-Melbourne",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Melbourne, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2021; 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.