Individual
CORAL SIMANTOV-MAMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2051 SAM RITTENBERG BLVD, CHARLESTON, SC 29407-4683
(843) 779-6844
Mailing address
709 PEPPERBUSH ST, CHARLESTON, SC 29414-8238
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DGD.10522
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/31/2022
Last updated
06/13/2023
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