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General NPI Number Information
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NPI Number | 1639210131
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Entity Type | Organization
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Legal Business Name | EMERALD COAST DENTISTRY
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 931 MAR WALT DR
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-6759
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Country | US
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Telephone | 850-863-1722
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Fax | 850-863-5189
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Provider Business Mailing Address
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Address Line | 931 MAR WALT DR
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-6759
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Country | US
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Telephone | 850-863-1722
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Fax | 850-863-5189
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ERIN BETH SUTTON
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Credential | DMD
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Telephone | 850-863-1722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN14952
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License Number State | FL
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