COASTAL KIDS DENTAL (NPI# 1093117558) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093117558 |
| Entity Type | Organization |
| Organization Name | COASTAL KIDS DENTAL |
| Practice Address |
808 Wappoo Rd Charleston SC 29407-5865 |
| Practice Telephone | 8438185437 |
| Practice Fax Number | 8437251594 |
| Mailing Telephone | 8438185437 |
| Mailing Fax Number | 8437251594 |
| Enumeration Date | 2014-09-16 |
| Last Update Date | 2014-09-16 |
| Authorized Official Name | MR. JACOB DRIGGERS (OWNER) |
| Authorized Official Telephone | 8438185437 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223G0001X |
Dentist Specialization: General Practice |
Dental Providers | ||
| N | 1223X0400X |
Dentist Specialization: Orthodontics and Dentofacial Orthopedics |
Dental Providers | ||
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801036637 | Coastal Kids Dental | Dentist | 1931 Strathmoor Blvd, Louisville, KY 40205-2525 | 2009-03-06 |
| 1659693695 | Coastal Kids Dental | Dentist | 1000 Tanner Ford Blvd, Suite 370, Hanahan, SC 29410-4707 | 2010-02-18 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Colorado Business Entities | Coastal Kids Dental PA | 808 Wappoo Road, Charleston, SC 29407 |
| Street Address |
808 WAPPOO RD |
| City | CHARLESTON |
| State | SC |
| Zip Code | 29407-5865 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669726048 | Dentistry for Children of South Carolina, PC | Dentist | 808 Wappoo Rd, Charleston, SC 29407 | 2012-11-06 |
| 1285090423 | Jeffrey Mirrielees | Dentist | 808 Wappoo Rd, Charleston, SC 29407-5865 | 2016-01-04 |
| 1952783094 | Karen Konomi Wolf | Dentist | 808 Wappoo Rd, Charleston, SC 29407-5865 | 2015-06-25 |
| 1841689247 | Coastal Kids Dental & Braces | Dentist | 808 Wappoo Rd, Charleston, SC 29407-5865 | 2015-01-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437763661 | Charleston Jaw Surgery | Oral & Maxillofacial Surgery | 846 St. Andrews Blvd., Charleston, SC 29407 | 2020-09-04 |
| 1780225128 | New Endeavors Counseling | Social Worker | 1 Carriage Lane Building E Suite 202, Charleston, SC 29407 | 2019-10-07 |
| 1770063158 | Katelyn Campbell | Psychologist | 1 Carriage Ln Ste 102, Charleston, SC 29407 | 2018-08-15 |
| 1164929956 | Anisha Gulati Md LLC | Psychiatry & Neurology | 925 Wappoo Rd., Suite F, Charleston, SC 29407 | 2018-04-09 |
| 1316459753 | David W Richardson | Dentist | 765 St. Andrews Blvd., Charleston, SC 29407 | 2017-10-25 |
| 1457874174 | Meca Mentality LLC | Chiropractor | 1106 St Andrews Blvd Suite A, Charleston, SC 29407 | 2017-07-25 |
| 1639609373 | Carolina Behavioral Specialists, LLC | Behavioral Analyst | 1529 Sam Rittenberg Blvd, Unit 1-b, Charleston, SC 29407 | 2017-06-15 |
| 1467991901 | Bernice Ladson | Registered Nurse | 75o Magnolia Road, Charleston, SC 29407 | 2017-02-16 |
| 1376991257 | Virginia Leigh Thomason | Counselor | 29 Leinbach Dr, Suite D2, Charleston, SC 29407 | 2016-06-01 |
| 1609221001 | Elinor Lee Smith | Counselor | 571 Savannah Hwy, Charleston, SC 29407 | 2016-05-04 |
| Find all providers in zip 29407 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669726048 | Dentistry for Children of South Carolina, PC | Dentist | 808 Wappoo Rd, Charleston, SC 29407 | 2012-11-06 |
| 1346464674 | Cornerstone Children's Dentistry, P.a. | Dentist | 2075-a Charlie Hall Blvd., Charleston, SC 29414-5834 | 2007-04-11 |
| 1760501001 | Tracy L. Wilkerson, Dds, Pllc | Dentist | 1400 Kanawha Blvd E, Charleston, WV 25301-3002 | 2007-03-28 |
| 1902902992 | Erin Lewis Nichols | Dentist | 1721 Oak Point Rd, Charleston, SC 29412-2838 | 2006-09-16 |
| 1104874924 | Howard Peskin | Dentist | 494 Savannah Hwy, Charleston, SC 29407-7275 | 2006-05-04 |
| 1528024460 | Tracy Lynn Wilkerson | Dentist | 1400 Kanawha Boulevard East, Charleston, WV 25301 | 2006-04-20 |
| 1720061005 | Paul A. Galloway | Dentist | 2075 Charlie Hall Blvd, Suite A, Charleston, SC 29414-5834 | 2005-11-21 |
| 1164427795 | Ashley Jane Patnoe | Dentist | 1538b Kanawha Blvd E, Charleston, WV 25311-2413 | 2005-06-20 |
| 1922620871 | Alex Emily Sherman | Dentist | 169 Ashley Ave, Room 202 Main Hospital Msc333, Charleston, SC 29425 | 2020-05-14 |
| 1952783094 | Karen Konomi Wolf | Dentist | 808 Wappoo Rd, Charleston, SC 29407-5865 | 2015-06-25 |
| Find all providers in CHARLESTON | ||||
| City | CHARLESTON |
| Zip Code | 29407 |
Please comment or provide details below to improve the information on COASTAL KIDS DENTAL.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.