NPIMap

Organization Active NPI

Coastal Kids Dental & Braces

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • North Charleston, SC
National Provider Identifier
1124417522
Registry record updated Jan 22, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
4476 Issued in SC
Legal business name
COASTAL KIDS DENTAL & BRACES
Practice address
8600 Dorchester Rd
Ste 104
North Charleston, SC 29420-7382
Phone
(843) 818-5437
Fax
(843) 725-1594
NPI assigned
Jan 22, 2015
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Jacob Driggers
Title
Coo
Phone
(843) 818-5437

Corporate family (same tax ID) 4

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

National Provider Directory
Tax ID family
Coastal Kids Dental Braces (5 organizations share this tax ID)

Locations

8600 Dorchester Rd
Ste 104
North Charleston, SC 29420

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223X0400X 4476 SC Primary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223X0400X 4209 SC

Addresses

NPPES NPI Registry

Primary practice location

8600 Dorchester Rd
Ste 104
North Charleston, SC 29420-7382

Mailing address

808 Wappoo Rd
Charleston, SC 29407-5865
Phone (843) 818-5437

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 22, 2015.

{
    "created_epoch": "1421884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421884800000",
    "number": "1124417522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 WAPPOO RD",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294075865",
            "telephone_number": "843-818-5437",
            "fax_number": "843-725-1594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8600 DORCHESTER RD",
            "address_2": "STE 104",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294207382",
            "telephone_number": "843-818-5437",
            "fax_number": "843-725-1594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL KIDS DENTAL & BRACES",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-22",
        "last_updated": "2015-01-22",
        "status": "A",
        "authorized_official_last_name": "DRIGGERS",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "843-818-5437"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "SC",
            "license": "4476",
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "SC",
            "license": "4209",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Charleston, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.