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General NPI Number Information
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NPI Number | 1740995430
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Entity Type | Organization
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Legal Business Name | COASTAL DENTURES & IMPLANTS
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Dates
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Enumeration Date | 01/18/2023
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Last Update Date | 06/26/2023
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Provider Practice Location Address
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Address Line | 6213 WASHINGTON AVE
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-2664
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Country | US
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Telephone | 228-215-0801
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Fax | 228-367-0007
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Provider Business Mailing Address
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Address Line | 4010 COMMERCE DR
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City | KINSTON
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State | NC
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Zip | 28504-7906
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Country | US
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Telephone | 252-208-4430
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | DR. JEFF ZIMMERMAN
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Credential | DDS
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Telephone | 228-342-6225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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