Organization
COASTAL DENTAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRADLEY B TILLER D.M.D (CEO)
(843) 651-0314
Entity
Organization
Contact information
Practice address
11990 HWY 17 BYPASS UNIT 8, MURRELLS INLET, SC 29576-7790
(843) 651-0314
(843) 651-3662
Mailing address
11990 HWY 17 BYPASS UNIT 8, MURRELLS INLET, SC 29576-7790
(843) 651-0314
(843) 651-3662
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
SC3537
SC
Other
Enumeration date
04/08/2016
Last updated
04/26/2017
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