Coastal Carolina Oral Maxillofacial Surgery

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

COASTAL CAROLINA ORAL MAXILLOFACIAL SURGERY

Practice address

133 Towne Centre Pkwy
Myrtle Beach, SC 29579

Phone

(843) 448-1621

Fax

(843) 626-2501

NPI assigned

Oct 9, 2006

Last updated

Apr 11, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Wilma Pond

Title

Practice Administrator

Phone

(843) 448-1621

Specialties & licenses 2

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Chad Spencer Adams, DDS

  • Student in an Organized Health Care Education/Training Program
  • Myrtle Beach, SC
  • NPI 1972966315
  NPD
• Michael Allan Johnson, DDS

  • Dentist
  • Myrtle Beach, SC
  • NPI 1427324243

  Oral and Maxillofacial Surgery

  NPD
• Jeffrey E Aycock, DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Winston Salem, NC
  • NPI 1568693877
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712793600000",
    "number": "1194812339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "133 TOWNE CENTRE PKWY",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "29579",
            "telephone_number": "843-448-1621",
            "fax_number": "843-626-2501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 TOWNE CENTRE PKWY",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "29579",
            "telephone_number": "843-448-1621",
            "fax_number": "843-626-2501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL CAROLINA ORAL MAXILLOFACIAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-09",
        "last_updated": "2024-04-11",
        "certification_date": "2024-04-11",
        "status": "A",
        "authorized_official_last_name": "POND",
        "authorized_official_first_name": "WILMA",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "843-448-1621"
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Coastal Cardiovascular Surgery, LLC
• Coastal Care Health Network LLC (Coastal Care)
• Coastal Carolina Allergy & Asthma Associates, PC
• Coastal Carolina Cosmetic Facial Surgery
• Coastal Carolina Infectious Disease, LLC
• Coastal Carolina Otolaryngology Associates,PA
• Coastal Carolina Primary Care, LLC
• Coastal Center for Cognitive Therapy, PA
• Coastal Dermatology Institute LLC
• Coastal DME LLC

• Oral and Maxillofacial Surgery (Dentist) in Myrtle Beach, SC
• Providers in Myrtle Beach, SC by specialty
• Oral and Maxillofacial Surgery (Dentist) in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2024; 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.