| NPI | 1548659022 |
|---|---|
| Doing Business As | COASTAL KIDS DENTAL & BRACES |
| Entity Type | Organization |
| Authorized Contact | JACOB DRIGGERS COO 843-818-5437 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: SC 3889) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 3889) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: SC 4476) | |
| Enumeration Date | 2015-01-21 |
| Last Update Date | 2015-01-21 |