Healthcare Provider Details

I. General information

NPI: 1972257095
Provider Name (Legal Business Name): ZEST PEDIATRIC DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 02/17/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 SAMS POINT RD STE B
BEAUFORT SC
29907-2008
US

IV. Provider business mailing address

37 SAMS POINT RD STE B
BEAUFORT SC
29907-2008
US

V. Phone/Fax

Practice location:
  • Phone: 865-773-8687
  • Fax:
Mailing address:
  • Phone: 843-321-9944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. KAREN KONOMI WOLF
Title or Position: PEDIATRIC DENTIST
Credential: DMD
Phone: 843-321-9944