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General NPI Number Information
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NPI Number | 1053457960
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Entity Type | Individual
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Provider Name | LAWRENCE GARY MILLER JR. D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 01/30/2026
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Provider Practice Location Address
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Address Line | 29 BEE ST
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City | CHARLESTON
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State | SC
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Zip | 29425-0001
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Country | US
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Telephone | 864-921-0335
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Fax |
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Provider Business Mailing Address
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Address Line | 400 SUNSET RD
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City | LANDRUM
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State | SC
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Zip | 29356-8826
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Country | US
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Telephone | 864-699-9931
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Fax | 864-699-9932
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 4109
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 784
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License Number State | SC
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