NPIMap

Organization Active NPI

Coast Florida P.a.

Doing business as Coast Dental-Lake Mary

  • Dentist
  • Lake Mary, FL
National Provider Identifier
1457927865
Registry record updated May 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
COAST FLORIDA P.A.
Doing business as
Coast Dental-Lake Mary
Practice address
2500 W Lake Mary Blvd Ste 106
Lake Mary, FL 32746-3501
Phone
(407) 328-6411
Fax
(407) 328-6444
NPI assigned
May 27, 2021
Last updated
May 27, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
COAST FLORIDA P.A.As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 27, 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

2500 W Lake Mary Blvd Ste 106
Lake Mary, FL 32746-3501

Mailing address

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

Other names 1

  • Coast Dental-Lake Mary 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

2500 W Lake Mary Blvd
Ste 106
Lake Mary, FL 32746
Phone (407) 328-6411

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 10

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": "1622073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622073600000",
    "number": "1457927865",
    "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": "2500 W LAKE MARY BLVD STE 106",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327463501",
            "telephone_number": "407-328-6411",
            "fax_number": "407-328-6444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COAST FLORIDA P.A.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COAST FLORIDA P.A.",
        "enumeration_date": "2021-05-27",
        "last_updated": "2021-05-27",
        "certification_date": "2021-05-27",
        "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-Lake Mary",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Mary, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 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.