Provider Demographics
NPI:1598103277
Name:NIMMICH, MATTHEW CHARLES (DMD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:CHARLES
Last Name:NIMMICH
Suffix:
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 1:9310 TWO NOTCH RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-6416
Mailing Address - Country:US
Mailing Address - Phone:803-699-5900
Mailing Address - Fax:803-788-9036
Practice Address - Street 1:9310 TWO NOTCH RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-6416
Practice Address - Country:US
Practice Address - Phone:803-699-5900
Practice Address - Fax:803-788-9036
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20181223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery