Organization
COASTAL KIDS DENTAL,PA
Active
Other names
Coastal Kids Dental & Braces
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACOB DRIGGERS (COO)
(843) 818-5437
Entity
Organization
Contact information
Practice address
118 S WALTER ST, WALTERBORO, SC 29488-3956
(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
122300000X
Dentist
3889
SC
1223P0221X
Pediatric Dentistry
Primary
3889
SC
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
4476
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZA9380
—
SC
Enumeration date
01/21/2015
Last updated
01/21/2015
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