Provider Demographics
NPI:1629800263
Name:COASTLINE DENTAL IMPLANTS PLLC
Entity type:Organization
Organization Name:COASTLINE DENTAL IMPLANTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ASHTON
Authorized Official - Middle Name:
Authorized Official - Last Name:DAHMS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:239-530-8165
Mailing Address - Street 1:15300 S JOG RD STE 210
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-2166
Mailing Address - Country:US
Mailing Address - Phone:239-530-8165
Mailing Address - Fax:
Practice Address - Street 1:15300 S JOG RD STE 211
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-2166
Practice Address - Country:US
Practice Address - Phone:561-499-6664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty