COASTAL CAROLINA COSMETIC FACIAL SURGERY
NPI 1972081941
Clinic/Center - Oral and Maxillofacial Surgery in Myrtle Beach, SC

Q: What is the provider's specialty?

The provider's specialty is Clinic/Center with taxonomy code 261QS0112X and a focus in Oral and Maxillofacial Surgery.

Active since August 01, 2018

133 TOWNE CENTRE PKWY, MYRTLE BEACH, SC 29579(843) 448-1621 Get Directions Write a Review

NPPES record last updated: December 10, 2019. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Dec 10, 2019, Aug 1, 2018 (2 updates tracked since 2018).

Table of Contents

NPI Profile Information
Primary Taxonomy
Authorized Official
Other Providers Same Location
Frequently Asked Questions

Organization
Clinic/Center
Oral and Maxillofacial Surgery

About COASTAL CAROLINA COSMETIC FACIAL SURGERY

This page provides the complete NPI Profile along with additional information for Coastal Carolina Cosmetic Facial Surgery, a provider established in Myrtle Beach, South Carolina operating as a Clinic/center, focusing in oral and maxillofacial surgery . The healthcare provider is registered in the NPI registry with number 1972081941 assigned on August 2018. The practitioner's primary taxonomy code is 261QS0112X with license number 8911 (SC). The provider is registered as an organization and their NPI record was last updated 7 years ago. The authorized official of this NPI record is Michael Johnson Dds (Managing Member)

NPI: 1972081941 Verify this NPI
Provider Name: COASTAL CAROLINA COSMETIC FACIAL SURGERY
Entity Type: Organization
Location Address: 133 TOWNE CENTRE PKWY MYRTLE BEACH, SC 29579
Location Phone: (843) 448-1621
Mailing Address: 6210 N OCEAN BLVD MYRTLE BEACH, SC 29572
Mailing Phone: (720) 201-5801
Is Sole Proprietor?: No
Is Organization Subpart?: No
Enumeration Date: 08-01-2018
Last Update Date: 12-10-2019
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Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification: Clinic/Center Oral and Maxillofacial Surgery
Taxonomy Code: 261QS0112X
Type: Ambulatory Health Care Facilities
License No.: 8911
License State: SC
Taxonomy Description: An oral and maxillofacial surgery clinic or center specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name: MICHAEL JOHNSON DDS
Authorized Official Title: MANAGING MEMBER
Authorized Official Phone: (720) 201-5801