=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750250056
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEST COAST DENTAL PARTNERS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2025
-----------------------------------------------------
Last Update Date | 11/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2431 S DIXIE HWY
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33401-7935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-659-5566
-----------------------------------------------------
Fax | 813-315-7224
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2431 S DIXIE HWY
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33401-7935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-659-5566
-----------------------------------------------------
Fax | 813-315-7224
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING MANAGER
-----------------------------------------------------
Name | JULI RENEE MIETZNER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 217-540-5651
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------