Provider Demographics
NPI:1053457960
Name:MILLER, LAWRENCE GARY JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:GARY
Last Name:MILLER
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-2271
Mailing Address - Country:US
Mailing Address - Phone:864-699-9931
Mailing Address - Fax:864-699-9932
Practice Address - Street 1:263 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-2271
Practice Address - Country:US
Practice Address - Phone:864-699-9931
Practice Address - Fax:864-699-9932
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2012-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4109122300000X
SC7841223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX4109Medicaid