Provider Demographics
NPI:1902690597
Name:SOUTH COAST ENDODONTICS
Entity type:Organization
Organization Name:SOUTH COAST ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MIROSLAVA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-201-2824
Mailing Address - Street 1:5525 S STAPLES ST STE A4
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-5362
Mailing Address - Country:US
Mailing Address - Phone:361-881-4260
Mailing Address - Fax:361-881-4292
Practice Address - Street 1:5525 S STAPLES ST STE A4
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-5362
Practice Address - Country:US
Practice Address - Phone:361-881-4260
Practice Address - Fax:361-881-4292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty