Healthcare Provider Details

I. General information

NPI: 1740396084
Provider Name (Legal Business Name): CHARLES E MILLWOOD JR DMD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 STATE STREET
CAYCE SC
29033
US

IV. Provider business mailing address

1313 STATE STREET
CAYCE SC
29033
US

V. Phone/Fax

Practice location:
  • Phone: 803-796-1734
  • Fax: 803-796-5041
Mailing address:
  • Phone: 803-796-1734
  • Fax: 803-796-5041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1857
License Number StateSC

VIII. Authorized Official

Name: DR. CHARLES EDWARD MILLWOOD JR.
Title or Position: DENTIST
Credential: DMD
Phone: 803-796-1734