COASTAL CAROLINA COSMETIC FACIAL SURGERY (NPI# 1972081941) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972081941 |
| Entity Type | Organization |
| Organization Name | COASTAL CAROLINA COSMETIC FACIAL SURGERY |
| Practice Address |
133 Towne Centre Pkwy Myrtle Beach SC 29579-3493 |
| Mailing Address |
6210 N Ocean Blvd Myrtle Beach SC 29572-3300 |
| Practice Telephone | 8434481621 |
| Mailing Telephone | 7202015801 |
| Enumeration Date | 2018-08-01 |
| Last Update Date | 2019-12-10 |
| Authorized Official Name | MICHAEL JOHNSON (MANAGING MEMBER) |
| Authorized Official Telephone | 7202015801 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QS0112X |
Clinic/Center Specialization: Oral and Maxillofacial Surgery |
8911 | SC | Ambulatory Health Care Facilities |
| Street Address |
133 TOWNE CENTRE PKWY |
| City | MYRTLE BEACH |
| State | SC |
| Zip Code | 29579-3493 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194812339 | Coastal Carolina Oral Maxillofacial Surgery | Dentist | 133 Towne Centre Pkwy, Myrtle Beach, SC 29579 | 2006-10-09 |
| 1538509831 | Michael Reece Cofer | Dentist | 133 Towne Centre Pkwy, Myrtle Beach, SC 29579-3493 | 2013-07-01 |
| 1427324243 | Michael Allan Johnson | Dentist | 133 Towne Centre Pkwy, Myrtle Beach, SC 29579-3493 | 2012-03-27 |
| 1770672503 | Brian C Harsha | Dentist | 133 Towne Centre Pkwy, Myrtle Beach, SC 29579 | 2006-10-12 |
| 1245329051 | Edward F. Eckert Jr. | Dentist | 133 Towne Centre Pkwy, Myrtle Beach, SC 29579 | 2006-10-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598323198 | P & E Company | Counselor | 4105 Carolina Commercial Dr. Unit #2, Myrtle Beach, SC 29579 | 2019-05-30 |
| 1528624632 | Matthew Meehan | Nurse Practitioner | 4016 River Oaks Dr # 6511, Myrtle Beach, SC 29579 | 2019-05-14 |
| 1427518265 | Brian Donovan Doherty | Student in an Organized Health Care Education/Training Program | Grand Strand Medical Center 809 82nd Parkway, Gme Office, Myrtle Beach, SC 29579 | 2019-03-20 |
| 1508347931 | South Carolina Cvs Pharmacy LLC | Pharmacy | 578 International Dr, Myrtle Beach, SC 29579 | 2018-08-23 |
| 1497256176 | Orthosc LLC | Orthopaedic Surgery | 185 Fresh Dr Ste B, Myrtle Beach, SC 29579 | 2018-02-27 |
| 1740708981 | Dental Professional of South Carolina, P.C. | Dentist | 568 International Dr, Myrtle Beach, SC 29579 | 2017-09-08 |
| 1093232480 | Johnathan T Steppe | Dentist | 568 International Drive, Myrtle Beach, SC 29579 | 2017-08-25 |
| 1346638483 | Little River Medical Center, Inc | Clinic/Center | 4220 Carolina Exchange Blvd, Myrtle Beach, SC 29579 | 2014-12-23 |
| 1154726818 | Mina Gaid | Pharmacist | 1303 38th Avenue North, Myrtle Beach, SC 29579 | 2014-10-23 |
| 1528471364 | Paola Goyeneche | Counselor | 5015 Carolina Forest Blvd, Myrtle Beach, SC 29579 | 2014-06-10 |
| Find all providers in zip 29579 | ||||
| Taxonomy Code | 261QS0112X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144683632 | Apex Oral Surgery, Inc | Clinic/Center | 664 Long Point Rd Unit B, Unit B, Mt Pleasant, SC 29464-8316 | 2016-04-01 |
| 1841695855 | Brian R Cherry LLC | Clinic/Center | 225 Halton Rd Ste B, Greenville, SC 29607-3499 | 2014-11-03 |
| 1477867281 | R Jason J Hehr, Dmd, LLC | Clinic/Center | 5401 Netherby Rd, Suite 1200, North Charleston, SC 29420-7363 | 2010-08-04 |
| 1932169273 | Greenville Ear Nose & Throat | Clinic/Center | 200 Patewood Dr, Building B Suite B400, Greenville, SC 29615-3593 | 2006-03-23 |
| City | MYRTLE BEACH |
| Zip Code | 29579 |
Please comment or provide details below to improve the information on COASTAL CAROLINA COSMETIC FACIAL SURGERY.
| 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.