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General NPI Number Information
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NPI Number | 1801036637
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Entity Type | Organization
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Legal Business Name | COASTAL KIDS DENTAL
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Dates
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Enumeration Date | 03/06/2009
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Last Update Date | 04/01/2009
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Provider Practice Location Address
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Address Line | 1931 STRATHMOOR BLVD
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City | LOUISVILLE
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State | KY
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Zip | 40205-2525
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Country | US
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Telephone | 843-478-8437
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 TANNER FORD BLVD SUITE 370
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City | HANAHAN
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State | SC
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Zip | 29410-4707
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Country | US
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Telephone | 843-478-8437
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | ISABEL GHOWANLU DRIGGERS
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Credential | DMD
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Telephone | 843-478-8437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | SC3889
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License Number State | SC
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