| NPI | 1184155962 |
|---|---|
| Doing Business As | COASTAL PEDIATRIC DENTAL & ANESTHESIA |
| Entity Type | Organization |
| Authorized Contact | JONATHAN LAWRENCE WONG Dentist Anesthesiologist, Owner 602-799-1748 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: VA 0447000045) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401414467) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401413751) | |
| Enumeration Date | 2017-03-23 |
| Last Update Date | 2024-02-17 |