MEDICARE: COUZENS DENTAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	1223G0001X	General Practice Dentistry	7025	KY

General Provider Information

NPI Number	:	1417090457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUZENS DENTAL LLC

Provider Business Mailing Address
First Line	:	21 NEW ORLEANS RD STE A
Second Line	:
City	:	HILTON HEAD ISLAND
State	:	SC
Zip	:	29928-4797
Country	:	US
Telephone Number	:	843-785-6285
Fax Number	:	843-785-8206

Provider Business Practice Location Address
First Line	:	21 NEW ORLEANS RD STE A
Second Line	:
City	:	HILTON HEAD ISLAND
State	:	SC
Zip	:	29928-4797
Country	:	US
Telephone Number	:	859-236-4304
Fax Number	:	843-785-8206

Authorized Official
Title or Position	:	DENTIST
Name	:	SUSAN HALE COUZENS
Credential	:	DMD
Telephone Number	:	843-785-6285

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	02/04/2025

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