Coastal Jaw Surgery of New Port Richey, P.a.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DN10802 Issued in FL

Legal business name

COASTAL JAW SURGERY OF NEW PORT RICHEY, P.A.

Practice address

2720 Park Dr
Clearwater, FL 33763-1020

Phone

(727) 726-8500

Fax

(727) 725-9716

NPI assigned

Nov 17, 2008

Last updated

Nov 17, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Mark Wayne Mitchell, D.D.S.NPI 1386634343

Title

President

Phone

(727) 842-5180

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

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.

• Mark Wayne Mitchell, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • New Port Richey, FL
  • NPI 1386634343
  NPD (past) Authorized official
• Reinaldo Claudio, D.M.D., M.D.

  • Oral and Maxillofacial Surgery (Dentist)
  • Clearwater, FL
  • NPI 1174717680
  NPD (past)

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

{
    "created_epoch": "1226880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226880000000",
    "number": "1710131826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6731 MADISON ST",
            "city": "NEW PORT RICHEY",
            "state": "FL",
            "postal_code": "346521928",
            "telephone_number": "727-842-5180",
            "fax_number": "727-846-0755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2720 PARK DR",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337631020",
            "telephone_number": "727-726-8500",
            "fax_number": "727-725-9716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL JAW SURGERY OF NEW PORT RICHEY, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-17",
        "last_updated": "2008-11-17",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "727-842-5180",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "FL",
            "license": "DN10802",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "072932900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Donald Bruce Cochran, OD OPTOMETRY DOCTOR
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• Oral and Maxillofacial Surgery (Dentist) in Clearwater, FL
• Providers in Clearwater, FL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2008; 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.