# COASTAL KIDS DENTAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659693695
- **Authorized official:** MR. JACOB G DRIGGERS (DIRECTOR OF OPERATIONS)
- **Authorized official phone:** (843) 818-4537

## Contact information

- **Practice address:** 1000 TANNER FORD BLVD, SUITE 370, HANAHAN, SC 29410-4707
- **Practice address phone:** (843) 818-5437
- **Practice address fax:** (843) 725-1594
- **Mailing address:** 216 E MAIN ST, MONCKS CORNER, SC 29461-3709
- **Mailing address phone:** (843) 818-5437
- **Mailing address fax:** (843) 725-1594

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | SC3889 | SC | Yes |

## Other

- **Enumeration date:** 02/18/2010
- **Last updated:** 02/18/2010