Provider Demographics
NPI:1952387896
Name:COASTAL CAROLINA FAMILY DENTISTRY, LLC
Entity Type:Organization
Organization Name:COASTAL CAROLINA FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:NIEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:843-760-6565
Mailing Address - Street 1:8471 RESOLUTE WAY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29420-7381
Mailing Address - Country:US
Mailing Address - Phone:843-760-6565
Mailing Address - Fax:843-760-6484
Practice Address - Street 1:8471 RESOLUTE WAY
Practice Address - Street 2:SUITE 104
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29420-7381
Practice Address - Country:US
Practice Address - Phone:843-760-6565
Practice Address - Fax:843-760-6484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental