Organization
COASTAL ORTHODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MALLOY GROVES SCOTT (OFFICER)
(843) 379-9200
Entity
Organization
Contact information
Practice address
1600 BURNSIDE ST, SUITE 105, BEAUFORT, SC 29902-3779
(843) 379-9200
Mailing address
1600 BURNSIDE ST, SUITE 105, BEAUFORT, SC 29902-3779
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
4410
SC
Other
Enumeration date
04/10/2012
Last updated
02/06/2015
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