NPIMap

Organization Active NPI

South Coast Dental Group LLC

Doing business as South Coast Family Dentistry

  • Dentist
  • Coos Bay, OR
National Provider Identifier
1790096402
Registry record updated May 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D9399 Issued in OR
Legal business name
SOUTH COAST DENTAL GROUP LLC
Doing business as
South Coast Family Dentistry
Practice address
295 S 10TH St
Coos Bay, OR 97420-4623
Phone
(541) 269-5353
Fax
(541) 266-0933
NPI assigned
Jun 28, 2010
Last updated
May 14, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 2026

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

Authorized official

Name
Mr. Nicholas I Horn
Title
Billing & Claims Manager
Phone
(541) 269-5353

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X D9399 OR Primary

Addresses

Primary practice location

295 S 10TH St
Coos Bay, OR 97420-4623

Mailing address

295 S 10TH St
Coos Bay, OR 97420-4623
Phone (541) 269-5353

Other practice location 1

155 Delaware Ave SE
Bandon, OR 97411-9471
Phone (541) 551-7347

Other names 2

  • South Coast Family Dentistry Doing business as
  • South Coast Dental Group Other name

National Provider Directory

National Provider Directory

Locations

295 S 10th St
Coos Bay, OR 97420
Phone (541) 269-5353

Practitioners & affiliated clinicians

Practitioners 7

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": "1277683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778716800000",
    "number": "1790096402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "295 S 10TH ST",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974204623",
            "telephone_number": "541-269-5353",
            "fax_number": "541-266-0933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "295 S 10TH ST",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974204623",
            "telephone_number": "541-269-5353",
            "fax_number": "541-266-0933"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "155 Delaware Ave SE",
            "address_purpose": "LOCATION",
            "city": "Bandon",
            "state": "OR",
            "postal_code": "974119471",
            "country_code": "US",
            "telephone_number": "541-551-7347",
            "fax_number": "541-266-0933",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTH COAST DENTAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-28",
        "last_updated": "2026-05-14",
        "certification_date": "2026-05-14",
        "status": "A",
        "authorized_official_last_name": "HORN",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "BILLING & CLAIMS MANAGER",
        "authorized_official_telephone_number": "541-269-5353",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D9399",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Coast Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "South Coast Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "South Coast Dental Group",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Coos Bay, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 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.