Provider Demographics
NPI:1922074186
Name:MILLWOOD, GREGORY A (DMD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:A
Last Name:MILLWOOD
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 1:1313 STATE ST
Mailing Address - Street 2:
Mailing Address - City:CAYCE
Mailing Address - State:SC
Mailing Address - Zip Code:29033
Mailing Address - Country:US
Mailing Address - Phone:803-796-1734
Mailing Address - Fax:803-796-5041
Practice Address - Street 1:1313 STATE ST
Practice Address - Street 2:
Practice Address - City:CAYCE
Practice Address - State:SC
Practice Address - Zip Code:29033
Practice Address - Country:US
Practice Address - Phone:803-796-1734
Practice Address - Fax:803-796-5041
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC39041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZA9552Medicaid