| NPI | 1568201192 |
|---|---|
| Doing Business As | COASTAL PALM ORTHODONTICS |
| Entity Type | Organization |
| Authorized Contact | RUSSELL BLAKE MCCRACKEN Owner 843-697-1423 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2024-05-22 |
| Last Update Date | 2024-05-22 |