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General NPI Number Information
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NPI Number | 1780106534
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Entity Type | Organization
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Legal Business Name | GULF COAST DENTISTRY LLC
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Dates
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Enumeration Date | 07/13/2017
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Last Update Date | 10/19/2021
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Provider Practice Location Address
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Address Line | 4427 ROWAN RD
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City | NEW PORT RICHEY
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State | FL
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Zip | 34653-6198
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Country | US
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Telephone | 813-385-2844
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Fax | 813-333-7323
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Provider Business Mailing Address
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Address Line | 16688 N DALE MABRY HWY
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City | TAMPA
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State | FL
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Zip | 33618-1400
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Country | US
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Telephone | 813-374-9695
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Fax | 813-333-7323
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Authorized Official
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Title or Position | OWNER
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Name | RONALD YARBROUGH
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Credential | DMD
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Telephone | 813-385-2844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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