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General NPI Number Information
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NPI Number | 1730759374
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Entity Type | Organization
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Legal Business Name | GULF COAST PERIODONTICS & IMPLANTS LLC
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Dates
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Enumeration Date | 06/27/2021
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Last Update Date | 06/27/2021
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Provider Practice Location Address
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Address Line | 11280 E TAYLOR RD
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City | GULFPORT
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State | MS
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Zip | 39503-4038
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Country | US
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Telephone | 228-868-9615
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Fax |
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Provider Business Mailing Address
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Address Line | 5024 KEYSTONE BLVD STE A
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City | COVINGTON
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State | LA
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Zip | 70433-7517
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Country | US
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Telephone | 985-778-0241
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Fax |
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Authorized Official
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Title or Position | SOLE MANAGER
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Name | DR. CAESAR SWEIDAN
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Credential | DDS
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Telephone | 228-868-9615
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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