Coast Palm Bay PL

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

COAST PALM BAY PL

Practice address

5706 Benjamin Center Dr Ste 103
Tampa, FL 33634

Phone

(813) 350-7160

Fax

(813) 434-2325

NPI assigned

Sep 27, 2006

Organization subpart

No

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

Authorized official

Name

Darlene Finnell

Title

Director of Credentialing

Phone

(813) 350-7160

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594252800000",
    "number": "1609967769",
    "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": "813-350-7160",
            "fax_number": "813-434-2325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5706 BENJAMIN CENTER DR STE 103",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "33634",
            "telephone_number": "813-350-7160",
            "fax_number": "813-434-2325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COAST PALM BAY PL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-27",
        "last_updated": "2020-07-09",
        "certification_date": "2020-07-09",
        "status": "A",
        "authorized_official_last_name": "FINNELL",
        "authorized_official_first_name": "DARLENE",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "813-350-7160"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2020; 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.