Organization
COASTAL KIDS DENTAL & BRACES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB DRIGGERS (COO)
(843) 818-5437
Entity
Organization
Contact information
Practice address
8600 DORCHESTER RD, STE 104, NORTH CHARLESTON, SC 29420-7382
(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
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
4209
SC
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
4476
SC
Other
Enumeration date
01/22/2015
Last updated
01/22/2015
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