Provider Demographics
NPI:1972257095
Name:ZEST PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:ZEST PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:KONOMI
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-321-9944
Mailing Address - Street 1:37 SAMS POINT RD STE B
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29907-2008
Mailing Address - Country:US
Mailing Address - Phone:843-321-9944
Mailing Address - Fax:
Practice Address - Street 1:37 SAMS POINT RD STE B
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29907-2008
Practice Address - Country:US
Practice Address - Phone:865-773-8687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-08
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty