Coastal Kids Pediatric Dentistry, LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

G1-0001296 Issued in DE

Legal business name

COASTAL KIDS PEDIATRIC DENTISTRY, LLC

Practice address

18947 John J Williams Hwy
Suite 309
Rehoboth Beach, DE 19971-4474

Phone

(610) 733-4300

NPI assigned

Apr 30, 2013

Last updated

May 4, 2016By 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. Jessica S Di Cerbo, D.M.D.NPI 1528258779

Title

Pediatric Dentist

Phone

(610) 733-4300

Specialties & licenses 1

Addresses

Other identifiers 4

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.

• Jessica Di Cerbo, D.M.D.

  • Pediatric Dentistry
  • Rehoboth Beach, DE
  • NPI 1528258779
  NPD (past) Authorized official
• Jeremy Maceo Irving, DMD

  • Pediatric Dentistry
  • Rehoboth Beach, DE
  • NPI 1891327466
  NPD (past)

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

{
    "created_epoch": "1367280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462320000000",
    "number": "1821433145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18947 JOHN J WILLIAMS HWY",
            "address_2": "SUITE 309",
            "city": "REHOBOTH BEACH",
            "state": "DE",
            "postal_code": "199714474",
            "telephone_number": "610-733-4300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18947 JOHN J WILLIAMS HWY",
            "address_2": "SUITE 309",
            "city": "REHOBOTH BEACH",
            "state": "DE",
            "postal_code": "199714474",
            "telephone_number": "610-733-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL KIDS PEDIATRIC DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-30",
        "last_updated": "2016-05-04",
        "status": "A",
        "authorized_official_last_name": "DI CERBO",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PEDIATRIC DENTIST",
        "authorized_official_telephone_number": "610-733-4300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "DE",
            "license": "G1-0001296",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL",
            "identifier": "1821433145",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1821433145",
            "state": "DE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GUARDIAN",
            "identifier": "171999",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "271596",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexander Chase, PA-C
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• Mieshia Staples Clark, DNP
• Melissa M Clendaniel, MS, NCC, LACMH
• Coastal Family Chiropractic, LLC
• Coastal Neuropsychology and Treatment Center LLC
• Collaborative Mental Health, LLC (Collaborative Mental Health DE)
• Peter B Collis, MD
• Candace Conaway, FNP-C
• Thomas Earl Conley, DDS

• Pediatric Dentistry in Rehoboth Beach, DE
• Providers in Rehoboth Beach, DE by specialty
• Pediatric Dentistry in Delaware

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2016; 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.