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General NPI Number Information
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NPI Number | 1992027676
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Entity Type | Organization
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Legal Business Name | COASTAL VIRGINIA ORAL AND MAXILLOFACIAL SURGERY, PC
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Dates
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Enumeration Date | 02/22/2010
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Last Update Date | 02/22/2010
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Provider Practice Location Address
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Address Line | 3720 HOLLAND RD SUITE 100
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-2859
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Country | US
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Telephone | 757-340-0446
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Fax | 757-340-2636
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Provider Business Mailing Address
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Address Line | 3720 HOLLAND RD SUITE 100
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-2859
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Country | US
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Telephone | 757-340-0446
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Fax | 757-340-2636
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL FRANK MAUGERI JR.
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Credential | DDS
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Telephone | 757-340-0446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 0401006030
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 0401411368
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 0401005985
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License Number State | VA
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