Individual
TIFFANY SAMANTHA COAXUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
51 NASSAU ST, CHARLESTON, SC 29403-5513
(843) 722-4112
Mailing address
118 HAINSWORTH DR, NORTH CHARLESTON, SC 29418-2736
(843) 492-3374
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
11083
SC
Other
Enumeration date
12/09/2022
Last updated
12/09/2022
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