Provider Demographics
NPI:1285317990
Name:GULF COAST DENTAL CARE OF BILOXI PLLC
Entity type:Organization
Organization Name:GULF COAST DENTAL CARE OF BILOXI PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:228-832-3231
Mailing Address - Street 1:232A EISENHOWER DR
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-3601
Mailing Address - Country:US
Mailing Address - Phone:228-388-9551
Mailing Address - Fax:228-832-0186
Practice Address - Street 1:232A EISENHOWER DR
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-3601
Practice Address - Country:US
Practice Address - Phone:228-388-9551
Practice Address - Fax:228-388-9552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-09
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental