| Organization Name: | COASTAL ORTHODONTICS |
| NPI Number: | 1013273549 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MALLOY GROVES SCOTT (OFFICER) |
| Mailing Address: | 1600 Burnside St Suite 105 Beaufort |
| State: | SC US |
| Postal Code: | 299023779 |
| Phone Number: | 8433799200 |
| Fax Number: | |
| NPI Enumeration Date: | 04/10/2012 |
| NPI Last Update Date: | 02/06/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 4410 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |