Organization
COASTAL KIDS DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACOB G DRIGGERS (DIRECTOR OF OPERATIONS)
(843) 818-4537
Entity
Organization
Contact information
Practice address
1000 TANNER FORD BLVD, SUITE 370, HANAHAN, SC 29410-4707
(843) 818-5437
(843) 725-1594
Mailing address
216 E MAIN ST, MONCKS CORNER, SC 29461-3709
(843) 818-5437
(843) 725-1594
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
SC3889
SC
Other
Enumeration date
02/18/2010
Last updated
02/18/2010
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