Healthcare Provider Details

I. General information

NPI: 1598973430
Provider Name (Legal Business Name): CAYCE FAMILY DENTISTRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 08/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 STATE ST
CAYCE SC
29033-4344
US

IV. Provider business mailing address

1313 STATE ST
CAYCE SC
29033-4344
US

V. Phone/Fax

Practice location:
  • Phone: 803-796-1734
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3904
License Number StateSC

VIII. Authorized Official

Name: DR. GREGORY A. MILLWOOD
Title or Position: DENTIST
Credential: D.M.D
Phone: 803-796-1734