Organization
COASTAL KIDS DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACOB DRIGGERS (OWNER)
(843) 818-5437
Entity
Organization
Contact information
Practice address
808 WAPPOO RD, CHARLESTON, SC 29407-5865
(843) 818-5437
(843) 725-1594
Mailing address
808 WAPPOO RD, CHARLESTON, SC 29407-5865
(843) 818-5437
(843) 725-1594
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
—
1223P0221X
Pediatric Dentistry
Primary
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
09/16/2014
Last updated
09/16/2014
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