NPIMap

Organization Active NPI

Coastal Kids Dental & Braces

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Moncks Corner, SC
National Provider Identifier
1932598331
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
216 E Main St
Moncks Corner, SC 29461-3709
Phone
(843) 818-5437
Fax
(843) 725-1594
NPI assigned
Jan 22, 2015
Organization subpart
Yes
Parent organization
COASTAL KIDS DENTAL, PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 22, 2015

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

Authorized official

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

Specialties & licenses 2

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

Primary practice location

216 E Main St
Moncks Corner, SC 29461-3709

Mailing address

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

National Provider Directory

National Provider Directory
Tax ID family
Coastal Kids Dental Braces5 organizations share this tax ID, including this one
Part of
Coastal Kids Dental

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": "1421884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421884800000",
    "number": "1932598331",
    "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": "216 E MAIN ST",
            "city": "MONCKS CORNER",
            "state": "SC",
            "postal_code": "294613709",
            "telephone_number": "843-818-5437",
            "fax_number": "843-725-1594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL KIDS DENTAL & BRACES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COASTAL KIDS DENTAL, PA",
        "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 Moncks Corner, 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.