Exceptional Dental of Long Beach, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

EXCEPTIONAL DENTAL OF LONG BEACH, LLC

Practice address

5107 Beatline Rd Ste 800
Long Beach, MS 39560-3879

Phone

(228) 250-0350

NPI assigned

Dec 6, 2021

Organization subpart

No

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

Authorized official

Name

Mrs. Samantha Coats

Title

Insurance Credentialing Manager

Phone

(504) 609-2599

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1638748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639353600000",
    "number": "1700544871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 GALLERIA BLVD STE 1518",
            "city": "METAIRIE",
            "state": "LA",
            "postal_code": "700012082",
            "telephone_number": "504-609-2599",
            "fax_number": "504-386-4956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5107 BEATLINE RD STE 800",
            "city": "LONG BEACH",
            "state": "MS",
            "postal_code": "395603879",
            "telephone_number": "228-250-0350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCEPTIONAL DENTAL OF LONG BEACH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-06",
        "last_updated": "2021-12-13",
        "certification_date": "2021-12-13",
        "status": "A",
        "authorized_official_last_name": "COATS",
        "authorized_official_first_name": "SAMANTHA",
        "authorized_official_title_or_position": "INSURANCE CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "504-609-2599",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "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 Dec 13, 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.