Organization Name: | COASTAL KIDS DENTAL |
NPI Number: | 1659693695 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JACOB G DRIGGERS (DIRECTOR OF OPERATIONS) |
Mailing Address: | 1000 Tanner Ford Blvd Suite 370 Hanahan |
State: | SC US |
Postal Code: | 294104707 |
Phone Number: | 8438185437 |
Fax Number: | 8437251594 |
NPI Enumeration Date: | 02/18/2010 |
NPI Last Update Date: | 02/18/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1223P0221X |
License Number: | SC3889 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SC |
Taxonomy Type: | Dental Providers |
Taxonomy Classification: | Dentist |
Taxonomy Specialization: | Pediatric Dentistry |
Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |