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	:	1184570806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST COAST DENTAL PARTNERS

Provider Business Mailing Address
First Line	:	101 E KENNEDY BLVD STE 300
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33602-5847
Country	:	US
Telephone Number	:	813-701-3141
Fax Number	:	813-200-2215

Provider Business Practice Location Address
First Line	:	101 E KENNEDY BLVD STE 300
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33602-5847
Country	:	US
Telephone Number	:	813-701-3141
Fax Number	:	813-200-2215

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	JULI RENEE MIETZNER
Credential	:
Telephone Number	:	217-540-5651

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/05/2026

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Directions to “WEST COAST DENTAL PARTNERS ” Practice Location

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