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General NPI Number Information
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NPI Number | 1265971972
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Entity Type | Organization
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Legal Business Name | CORAL SEAMOUNT DDS
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Dates
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Enumeration Date | 02/14/2017
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Last Update Date | 02/14/2017
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Provider Practice Location Address
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Address Line | 377 1ST ST
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City | SOLVANG
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State | CA
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Zip | 93463-2711
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Country | US
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Telephone | 561-212-3648
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Fax |
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Provider Business Mailing Address
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Address Line | 377 1ST ST
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City | SOLVANG
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State | CA
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Zip | 93463-2711
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Country | US
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Telephone | 561-212-3648
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | CORAL SEAMOUNT
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Credential | DDS
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Telephone | 561-212-3648
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DDS101065
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License Number State | CA
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