| NPI | 1104484864 |
|---|---|
| Doing Business As | COASTAL CAROLINA DENTAL CARE |
| Entity Type | Organization |
| Authorized Contact | JESSICA BRITT Credentialing Coordinator 217-540-5100 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2022-03-02 |