1265083315 NPI number — SEA PINES ORAL AND FACIAL SURGERY, PC

Table of content: BRIANNA NICOLE COSENTINO DPT (NPI 1124420658)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265083315 NPI number — SEA PINES ORAL AND FACIAL SURGERY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEA PINES ORAL AND FACIAL SURGERY, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265083315
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1301 FOUNTAIN PARK CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRUNSWICK
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31520-4860
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-254-4450
Provider Business Mailing Address Fax Number:
912-266-8696

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 FOUNTAIN PARK CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRUNSWICK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31520-4860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-254-4450
Provider Business Practice Location Address Fax Number:
912-266-8696
Provider Enumeration Date:
09/20/2019

Additional Information

Authorized Official

Authorized Official Last Name:
HAMMOND
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
JEREMY
Authorized Official Title or Position:
OFFICER
Authorized Official Telephone Number:
302-983-9707

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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