Healthcare Provider Details

I. General information

NPI: 1417090457
Provider Name (Legal Business Name): COUZENS DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 NEW ORLEANS RD STE A
HILTON HEAD ISLAND SC
29928-4797
US

IV. Provider business mailing address

21 NEW ORLEANS RD STE A
HILTON HEAD ISLAND SC
29928-4797
US

V. Phone/Fax

Practice location:
  • Phone: 859-236-4304
  • Fax: 843-785-8206
Mailing address:
  • Phone: 843-785-6285
  • Fax: 843-785-8206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7025
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: SUSAN HALE COUZENS
Title or Position: DENTIST
Credential: DMD
Phone: 843-785-6285