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

General Provider Information

NPI Number	:	1952977290
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	:	1912 W REYNOLDS ST
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33563-4700
Country	:	US
Telephone Number	:	813-567-7001
Fax Number	:	813-567-7006

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

1679525307 — DR. MARIA KATHLEEN MANSET HERMANO-SORIANO DDS
Practice Location Address:

1912 W REYNOLDS ST , SUITE A
PLANT CITY, FL
33563-4700

Practice Phone: 813-754-5142
Practice Fax: 813-752-7196

1285913723 — DR. STEPHEN RUSO D.D.S., M.S.
Practice Location Address:

1912 W REYNOLDS ST
PLANT CITY, FL
33563-4700

Practice Phone: 813-567-7001
Practice Fax:

1891391793 — FARSHAD NASTAEIN
Practice Location Address:

1912 W REYNOLDS ST
PLANT CITY, FL
33563-4700

Practice Phone: 813-567-7001
Practice Fax:

1174190987 — DR. CODY LOWE DMD
Practice Location Address:

1912 W REYNOLDS ST
PLANT CITY, FL
33563-4700

Practice Phone: 813-567-7001
Practice Fax:

1174217574 — NICOLE ANN POWER DMD
Practice Location Address:

1912 W REYNOLDS ST
PLANT CITY, FL
33563-4700

Practice Phone: 813-567-7001
Practice Fax:

1457357147 — DR. BRIAN M FORBES D.C.
Practice Location Address:

4700 NAMEOKI RD
GRANITE CITY, IL
62040-2524

Practice Phone: 618-797-2225
Practice Fax: 618-797-2289

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 © 2007-2025 (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.