| NPI | 1760058093 |
|---|---|
| Doing Business As | COAST DENTAL-LAKE CITY |
| Entity Type | Organization |
| Authorized Contact | MELODY RIVERA Credentialing Manager 813-350-7166 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2021-05-27 |
| Last Update Date | 2021-05-27 |