Provider Demographics
NPI:1700046406
Name:MILLER, MATTHEW (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 BROAD RIVER RD
Mailing Address - Street 2:SUITE L
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-6055
Mailing Address - Country:US
Mailing Address - Phone:803-772-4949
Mailing Address - Fax:
Practice Address - Street 1:2700 BROAD RIVER RD
Practice Address - Street 2:SUITE L
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-6055
Practice Address - Country:US
Practice Address - Phone:803-772-4949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08481122300000X
SC8472122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist