Healthcare Provider Details

I. General information

NPI: 1598103277
Provider Name (Legal Business Name): MATTHEW CHARLES NIMMICH D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 SALUDA RIDGE CT STE 400
WEST COLUMBIA SC
29169-3461
US

IV. Provider business mailing address

112 SALUDA RIDGE CT STE 400
WEST COLUMBIA SC
29169-3461
US

V. Phone/Fax

Practice location:
  • Phone: 980-243-3306
  • Fax:
Mailing address:
  • Phone: 980-243-3306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2018
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: