| NPI | 1639936172 |
|---|---|
| Doing Business As | COASTAL PEDIATRIC DENTAL & ANESTHESIA |
| Entity Type | Organization |
| Authorized Contact | JONATHAN L WONG Member 757-963-0001 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223D0004X Dentist, Dentist Anesthesiologist Speciality |
| 1223G0001X Dentist, General Practice | |
| 1223P0221X Dentist, Pediatric Dentistry | |
| Enumeration Date | 2024-03-01 |
| Last Update Date | 2024-03-01 |