# COASTAL KIDS DENTAL,PA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Coastal Kids Dental & Braces
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548659022
- **Authorized official:** MR. JACOB DRIGGERS (COO)
- **Authorized official phone:** (843) 818-5437

## Contact information

- **Practice address:** 118 S WALTER ST, WALTERBORO, SC 29488-3956
- **Practice address phone:** (843) 818-5437
- **Practice address fax:** (843) 725-1594
- **Mailing address:** 808 WAPPOO RD, CHARLESTON, SC 29407-5865
- **Mailing address phone:** (843) 818-5437
- **Mailing address fax:** (843) 725-1594

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 3889 | SC | — |
| 1223P0221X | Pediatric Dentistry | 3889 | SC | Yes |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | 4476 | SC | — |

## Other

- **Enumeration date:** 01/21/2015
- **Last updated:** 01/21/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZA9380 | — | SC |