Coastal Kids Dental
Dentist, Pediatric Dentistry in Louisville, KY. Organization (NPI-2).
NPI number1801036637
StatusActive
Last updated in NPPESApr 1, 2009
Details
- NPI
- 1801036637
- Entity type
- Organization (NPI-2)
- Legal business name
- Coastal Kids Dental
- Organization subpart
- No
- Enumeration date
- Mar 6, 2009
- Last updated
- Apr 1, 2009
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223P0221X | Dentist, Pediatric Dentistry | SC3889 | SC | Yes |
Practice location
1931 Strathmoor BlvdLouisville, KY 40205-2525
Phone 843-478-8437
Mailing address
1000 Tanner Ford BlvdSuite 370
Hanahan, SC 29410-4707
Phone 843-478-8437
Authorized official
Isabel Ghowanlu Driggers
Dentist/Owner
8434788437
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