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Organization
COASTAL COSMETIC DENTAL ASSOCIATES,
Active
Organization
COASTAL COSMETIC DENTAL ASSOCIATES,
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PATTY R VAN WIE DMD (PRES)
(843) 249-4092
Entity
Organization
Contact information
Practice address
1247 HIGHWAY 17, LITTLE RIVER, SC 29566-9211
(843) 249-4092
(843) 249-1638
Mailing address
PO BOX 635, LITTLE RIVER, SC 29566-0635
(843) 249-4092
(843) 249-1638
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2537
SC
Other
Enumeration date
02/22/2007
Last updated
08/22/2020
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