NPIMap

Organization Active NPI

Coastal Kids Dental

  • Pediatric Dentistry
  • Louisville, KY
National Provider Identifier
1801036637
Registry record updated Apr 1, 2009
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
1931 Strathmoor Blvd
Louisville, KY 40205-2525
Phone
(843) 478-8437
NPI assigned
Mar 6, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2009

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

Authorized official

Name
Isabel Ghowanlu Driggers, DMD
Title
Dentist/Owner
Phone
(843) 478-8437

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X SC3889 SC Primary

Addresses

Primary practice location

1931 Strathmoor Blvd
Louisville, KY 40205-2525

Mailing address

1000 Tanner Ford Blvd
Suite 370
Hanahan, SC 29410-4707
Phone (843) 478-8437

Other identifiers 1

IdentifierTypeStateIssuer
ZX3889MedicaidSC

National Provider Directory

National Provider Directory
Tax ID family
Coastal Kids Dental5 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": "1236297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238544000000",
    "number": "1801036637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 TANNER FORD BLVD",
            "address_2": "SUITE 370",
            "city": "HANAHAN",
            "state": "SC",
            "postal_code": "294104707",
            "telephone_number": "843-478-8437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1931 STRATHMOOR BLVD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402052525",
            "telephone_number": "843-478-8437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL KIDS DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-06",
        "last_updated": "2009-04-01",
        "status": "A",
        "authorized_official_last_name": "DRIGGERS",
        "authorized_official_first_name": "ISABEL",
        "authorized_official_middle_name": "GHOWANLU",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "843-478-8437",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "SC",
            "license": "SC3889",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZX3889",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2009; 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.