MEDICARE: COAST DENTAL P.A.

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	122300000X	Dentist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760058093
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COAST DENTAL P.A.

Provider Business Mailing Address
First Line	:	5706 BENJAMIN CENTER DR STE 103
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-5262
Country	:	US
Telephone Number	:	813-288-1999
Fax Number	:

Provider Business Practice Location Address
First Line	:	1166 SW MAIN BLVD
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-5780
Country	:	US
Telephone Number	:	386-752-7373
Fax Number	:	386-487-1265

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	MELODY RIVERA
Credential	:
Telephone Number	:	813-350-7166

Provider Enumeration Date	:	05/27/2021
Last Update Date	:	05/27/2021

Similar Medicare Providers

1912112541 — DR. MICHAEL L JARRELL DMD
Practice Location Address:

1166 SW MAIN BLVD
LAKE CITY, FL
32025-5780

Practice Phone: 386-752-7373
Practice Fax: 386-752-0056

1356946404 — STEPHANIE A AVERY RDH
Practice Location Address:

1166 SW MAIN BLVD
LAKE CITY, FL
32025-5780

Practice Phone: 386-752-7373
Practice Fax: 386-487-1265

1053349613 — CASCADE FAMILY EYE CARE, PLLC
Practice Location Address:

9623 32ND ST SE STE D121
LAKE STEVENS, WA
98258-5780

Practice Phone: 425-377-9747
Practice Fax: 425-377-8757

1841395449 — DR. JOHN RUMPAKIS O.D., M.B.A.
Practice Location Address:

5435 SOUTHWOOD DR
LAKE OSWEGO, OR
97035-5780

Practice Phone: 503-968-7595
Practice Fax:

1215070214 — TRACI S BIONDI MD
Practice Location Address:

2602 LAKE RIDGE SHRS W
RENO, NV
89519-5780

Practice Phone: 206-349-5952
Practice Fax:

1790040673 — DR. RODERICK BLAIR BEAZER O.D.
Practice Location Address:

9623 32ND ST SE STE D121
LAKE STEVENS, WA
98258-5780

Practice Phone: 425-377-9747
Practice Fax: 425-377-8757

Directions to “COAST DENTAL P.A. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.