NPIMap

Organization Active NPI

Coast Dental P.a.

Doing business as Coast Dental-Jacksonville

  • Dentist
  • Jacksonville, FL
National Provider Identifier
1508432840
Registry record updated May 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
COAST DENTAL P.A.
Doing business as
Coast Dental-Jacksonville
Practice address
445 State Road 13 Ste 22
Jacksonville, FL 32259-2821
Phone
(904) 209-6590
Fax
(904) 209-6595
NPI assigned
May 27, 2021
Last updated
May 27, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
COAST DENTAL 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
Dentist 122300000X Primary

Addresses

Primary practice location

445 State Road 13 Ste 22
Jacksonville, FL 32259-2821

Mailing address

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

Other names 1

  • Coast Dental-Jacksonville Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Coast Dental PA32 organizations share this tax ID, including this one
Part of
Coast Dental PA

Other organizations with this tax ID 31

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

View all 31

Locations

445 State Road 13 N
Ste 22
Jacksonville, FL 32259
Phone (904) 209-6590

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 6

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": "1508432840",
    "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": "445 STATE ROAD 13 STE 22",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322592821",
            "telephone_number": "904-209-6590",
            "fax_number": "904-209-6595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COAST DENTAL P.A.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COAST DENTAL 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": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coast Dental-Jacksonville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, 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.