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General NPI Number Information
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NPI Number | 1679954705
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Entity Type | Organization
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Legal Business Name | COAFS LAB
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Dates
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Enumeration Date | 06/15/2015
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Last Update Date | 06/15/2015
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Provider Practice Location Address
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Address Line | 125 WAPPOO CREEK DR STE C1
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City | CHARLESTON
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State | SC
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Zip | 29412-2161
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Country | US
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Telephone | 843-762-9028
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Fax | 843-762-9030
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Provider Business Mailing Address
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Address Line | 125 WAPPOO CREEK DR # C
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City | CHARLESTON
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State | SC
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Zip | 29412-2163
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Country | US
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Telephone | 843-762-9028
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Fax | 843-762-9030
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Authorized Official
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Title or Position | OWNER
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Name | DR. EDWARD STRAUSS
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Credential | DMD MD
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Telephone | 843-762-9028
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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