| Coastal Kids Dental | |
|
1931 Strathmoor Blvd Louisville KY 40205-2525 | |
| (843) 478-8437 | |
| Not Available |
| Full Name | Coastal Kids Dental |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1931 Strathmoor Blvd, Louisville, Kentucky |
| Authorized Official Name and Position | Isabel Ghowanlu Driggers (DENTIST/OWNER) |
| Authorized Official Contact | 8434788437 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastal Kids Dental 1000 Tanner Ford Blvd Suite 370 Hanahan SC 29410-4707 Ph: (843) 478-8437 | Coastal Kids Dental 1931 Strathmoor Blvd Louisville KY 40205-2525 Ph: (843) 478-8437 |
| NPI Number | 1801036637 |
|---|---|
| Provider Enumeration Date | 03/06/2009 |
| Last Update Date | 04/01/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801036637 | NPI | - | NPPES |
| ZX3889 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | SC3889 (South Carolina) | Primary |
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