MEDICARE: WEST COAST DENTAL PARTNERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1124992599
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST COAST DENTAL PARTNERS

Provider Business Mailing Address
First Line	:	751 HARLEY STRICKLAND BLVD
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-7947
Country	:	US
Telephone Number	:	386-406-9993
Fax Number	:

Provider Business Practice Location Address
First Line	:	751 HARLEY STRICKLAND BLVD
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-7947
Country	:	US
Telephone Number	:	386-406-9993
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	TINA CANALEJO HILLER
Credential	:
Telephone Number	:	813-389-4724

Provider Enumeration Date	:	09/30/2025
Last Update Date	:	09/30/2025

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Directions to “WEST COAST DENTAL PARTNERS ” Practice Location

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