Healthcare Provider Details

I. General information

NPI: 1649602228
Provider Name (Legal Business Name): SUSAN HALE COUZENS D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
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: 843-785-6285
  • Fax: 843-785-8206
Mailing address:
  • Phone: 843-785-6285
  • Fax: 843-785-8206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number7025
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number7025
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10126
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: