Healthcare Provider Details

I. General information

NPI: 1346755956
Provider Name (Legal Business Name): COASTAL VIRGINIA SLEEP SOLUTIONS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2017
Last Update Date: 12/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 WYTHE CREEK ROAD
POQUOSON VA
23662
US

IV. Provider business mailing address

235 WYTHE CREEK RD
POQUOSON VA
23662-1911
US

V. Phone/Fax

Practice location:
  • Phone: 757-868-8152
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM HARPER
Title or Position: PRESIDENT
Credential: DDS
Phone: 757-659-1017