Healthcare Provider Details

I. General information

NPI: 1114447703
Provider Name (Legal Business Name): COASTAL DENTAL SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FRANKTOWN COMMUNITY HEALTH CENTER 9159 FRANKTOWN ROAD
FRANKTOWN VA
23354
US

IV. Provider business mailing address

5460 BROCKIE ST
VIRGINIA BEACH VA
23464-7737
US

V. Phone/Fax

Practice location:
  • Phone: 757-414-0400
  • Fax:
Mailing address:
  • Phone: 757-965-5194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0443000025
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK D NEWMAN
Title or Position: PRESIDENT
Credential: DDS
Phone: 757-965-5194