Provider Demographics
NPI:1417090457
Name:COUZENS DENTAL LLC
Entity type:Organization
Organization Name:COUZENS DENTAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:HALE
Authorized Official - Last Name:COUZENS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-785-6285
Mailing Address - Street 1:21 NEW ORLEANS RD STE A
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29928-4797
Mailing Address - Country:US
Mailing Address - Phone:843-785-6285
Mailing Address - Fax:843-785-8206
Practice Address - Street 1:21 NEW ORLEANS RD STE A
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29928-4797
Practice Address - Country:US
Practice Address - Phone:859-236-4304
Practice Address - Fax:843-785-8206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY70251223G0001X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies