Provider Demographics
NPI:1538148606
Name:DUNES COSMETIC SURGERY LLC
Entity type:Organization
Organization Name:DUNES COSMETIC SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:F
Authorized Official - Last Name:COZART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-839-9202
Mailing Address - Street 1:4728 JENN DR
Mailing Address - Street 2:STE 106
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-0000
Mailing Address - Country:US
Mailing Address - Phone:843-839-9202
Mailing Address - Fax:
Practice Address - Street 1:1021 CIPRIANA DR
Practice Address - Street 2:STE 230
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4621
Practice Address - Country:US
Practice Address - Phone:843-839-9202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19982174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3891Medicaid
SC7908Medicare PIN
SCGP3891Medicaid