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General NPI Number Information
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NPI Number | 1497694749
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Entity Type | Organization
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Legal Business Name | COASTAL ORAL SURGERY
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Dates
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Enumeration Date | 03/25/2026
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Last Update Date | 03/25/2026
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Provider Practice Location Address
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Address Line | 5408 DISCOVERY PARK BLVD STE 101
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City | WILLIAMSBURG
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State | VA
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Zip | 23188-2893
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Country | US
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Telephone | 757-208-0138
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Fax | 757-206-1981
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Provider Business Mailing Address
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Address Line | 5408 DISCOVERY PARK BLVD STE 101
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City | WILLIAMSBURG
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State | VA
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Zip | 23188-2893
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Country | US
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Telephone | 757-784-2830
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Fax | 757-206-1981
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. KEVIN DANIEL KIELY
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Credential | DMD
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Telephone | 757-784-2830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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