Healthcare Provider Details

I. General information

NPI: 1679954705
Provider Name (Legal Business Name): COAFS LAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 06/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 WAPPOO CREEK DR STE C1
CHARLESTON SC
29412-2161
US

IV. Provider business mailing address

125 WAPPOO CREEK DR # C
CHARLESTON SC
29412-2163
US

V. Phone/Fax

Practice location:
  • Phone: 843-762-9028
  • Fax: 843-762-9030
Mailing address:
  • Phone: 843-762-9028
  • Fax: 843-762-9030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. EDWARD STRAUSS
Title or Position: OWNER
Credential: DMD MD
Phone: 843-762-9028