NPIMap

Organization Active NPI

Coastal Kids Dental

  • Pediatric Dentistry
  • Hanahan, SC
National Provider Identifier
1659693695
Registry record updated Feb 18, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
SC3889 Issued in SC
Legal business name
COASTAL KIDS DENTAL
Practice address
1000 Tanner Ford Blvd
Suite 370
Hanahan, SC 29410-4707
Phone
(843) 818-5437
Fax
(843) 725-1594
NPI assigned
Feb 18, 2010
Last updated
Feb 18, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2010

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

Authorized official

Name
Mr. Jacob G Driggers
Title
Director of Operations
Phone
(843) 818-4537

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X SC3889 SC Primary

Addresses

Primary practice location

1000 Tanner Ford Blvd
Suite 370
Hanahan, SC 29410-4707

Mailing address

216 E Main St
Moncks Corner, SC 29461-3709
Phone (843) 818-5437

National Provider Directory

National Provider Directory
Tax ID family
Coastal Kids Dental PA5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

NPI Registry JSON

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

{
    "created_epoch": "1266451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1266451200000",
    "number": "1659693695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "216 E MAIN ST",
            "city": "MONCKS CORNER",
            "state": "SC",
            "postal_code": "294613709",
            "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": "1000 TANNER FORD BLVD",
            "address_2": "SUITE 370",
            "city": "HANAHAN",
            "state": "SC",
            "postal_code": "294104707",
            "telephone_number": "843-818-5437",
            "fax_number": "843-725-1594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL KIDS DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-18",
        "last_updated": "2010-02-18",
        "status": "A",
        "authorized_official_last_name": "DRIGGERS",
        "authorized_official_first_name": "JACOB",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "843-818-4537",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "SC",
            "license": "SC3889",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hanahan, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2010; 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.