NPIMap

Organization Active NPI

Coastal Pediatric Dental & Anesthesia, a Division of Atlantic Dental Care

Doing business as Coastal Pediatric Dental & Anesthesia

  • Dentist
  • Norfolk, VA
National Provider Identifier
1639936172
Registry record updated Mar 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
COASTAL PEDIATRIC DENTAL & ANESTHESIA, A DIVISION OF ATLANTIC DENTAL CARE
Doing business as
Coastal Pediatric Dental & Anesthesia
Practice address
6161 Kempsville Cir Ste 345
Norfolk, VA 23502-3950
Phone
(757) 963-0001
Fax
(757) 961-9988
NPI assigned
Mar 1, 2024
Last updated
Mar 24, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
ATLANTIC DENTAL CARE, PLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 24, 2026

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

Authorized official

Name
Jonathan L Wong, DMDNPI 1225266430
Title
Dentist
Phone
(757) 963-0001

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X Primary
Dental AnesthesiologyGroup: 193200000X MULTI-SPECIALTY GROUP 1223D0004X
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X

Addresses

Primary practice location

6161 Kempsville Cir Ste 345
Norfolk, VA 23502-3950

Mailing address

6161 Kempsville Cir Ste 345
Norfolk, VA 23502-3950
Phone (757) 963-0001

Other names 2

  • Coastal Pediatric Dental & Anesthesia Doing business as
  • Jillian Reynolds DDS & Jonathan L Wong, DMD PLLC, A Division of Atlantic Dental Care Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Vernon E O'Berry Jr DDS15 organizations share this tax ID, including this one
Part of
Vernon E O'Berry Jr DDS

Other organizations with this tax ID 14

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

View all 14

Locations

6161 Kempsville Cir
Ste 345
Norfolk, VA 23502
Phone (757) 461-5656

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 1

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": "1709251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1774310400000",
    "number": "1639936172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6161 KEMPSVILLE CIR STE 345",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235023950",
            "telephone_number": "757-963-0001",
            "fax_number": "757-961-9988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6161 KEMPSVILLE CIR STE 345",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235023950",
            "telephone_number": "757-963-0001",
            "fax_number": "757-961-9988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL PEDIATRIC DENTAL & ANESTHESIA, A DIVISION OF ATLANTIC DENTAL CARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ATLANTIC DENTAL CARE, PLC",
        "enumeration_date": "2024-03-01",
        "last_updated": "2026-03-24",
        "certification_date": "2026-03-24",
        "status": "A",
        "authorized_official_last_name": "WONG",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "757-963-0001",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223D0004X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Dental Anesthesiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coastal Pediatric Dental & Anesthesia",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Jillian Reynolds DDS & Jonathan L Wong, DMD PLLC, A Division of Atlantic Dental Care",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Norfolk, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2026; 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.