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COASTAL KIDS DENTAL

Pediatric Dentistry

Louisville, Kentucky

Provider NPI: 1801036637

Organization Information:
Organization Name:  COASTAL KIDS DENTAL
Organization is not Subpart
Authorized Official:  ISABEL GHOWANLU DRIGGERS  DENTIST/OWNER  843-4788437

Practice Location:
1931 STRATHMOOR BLVD  LOUISVILLE, KY 40205 US
Tel: 843-478-8437  Fax: --

Business Mailing Address:
1000 TANNER FORD BLVD SUITE 370 HANAHAN, SC 29410 US
Tel: 843-478-8437  Fax: --

Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y1223P0221XDental Providers
Dentist
Pediatric Dentistry
SCSC3889

Other Provider Identifiers:

IssuerNumberStateType
ZX3889SC05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin



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