Organization
COASTAL CAROLINA COSMETIC FACIAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL JOHNSON DDS (MANAGING MEMBER)
(720) 201-5801
Entity
Organization
Contact information
Practice address
133 TOWNE CENTRE PKWY, MYRTLE BEACH, SC 29579-3493
(843) 448-1621
Mailing address
6210 N OCEAN BLVD, MYRTLE BEACH, SC 29572-3300
(720) 201-5801
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
8911
SC
Other
Enumeration date
08/01/2018
Last updated
12/10/2019
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