Provider Demographics
NPI:1679954705
Name:COAFS LAB
Entity Type:Organization
Organization Name:COAFS LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:STRAUSS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MD
Authorized Official - Phone:843-762-9028
Mailing Address - Street 1:125 WAPPOO CREEK DR # C
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-2163
Mailing Address - Country:US
Mailing Address - Phone:843-762-9028
Mailing Address - Fax:843-762-9030
Practice Address - Street 1:125 WAPPOO CREEK DR STE C1
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-2161
Practice Address - Country:US
Practice Address - Phone:843-762-9028
Practice Address - Fax:843-762-9030
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHARLESTON ORAL AND FACIAL SURGERY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty