Healthcare Provider Details

I. General information

NPI: 1922074186
Provider Name (Legal Business Name): GREGORY A MILLWOOD DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 STATE ST
CAYCE SC
29033
US

IV. Provider business mailing address

1313 STATE ST
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 Number3904
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: