MEDICARE: DR. SUSAN HALE COUZENS D.M.D.

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	122300000X	Dentist	7025	KY
2	332B00000X	Durable Medical Equipment & Medical Supplies	7025	KY
3	1223G0001X	General Practice Dentistry	10126	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10126	OTHER	SC	SOUTH CAROLINA DENTAL LICENSE

General Provider Information

NPI Number	:	1649602228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN HALE COUZENS D.M.D.

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	:	843-785-6285
Fax Number	:	843-785-8206

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2013
Last Update Date	:	04/28/2025

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