Provider Demographics
NPI:1962750935
Name:ATLANTIC COAST PROSTHODONTICS INC
Entity type:Organization
Organization Name:ATLANTIC COAST PROSTHODONTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITSITT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:386-239-7600
Mailing Address - Street 1:1509 MASON AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-4548
Mailing Address - Country:US
Mailing Address - Phone:386-239-7600
Mailing Address - Fax:
Practice Address - Street 1:1509 MASON AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-4548
Practice Address - Country:US
Practice Address - Phone:386-239-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-24
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 106691223P0700X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty