Provider Demographics
NPI:1972553881
Name:MARIAN MITCHELL OLIVER CORPORATION
Entity Type:Organization
Organization Name:MARIAN MITCHELL OLIVER CORPORATION
Other - Org Name:MCMILLAN DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:DELANO
Authorized Official - Last Name:MCMILLAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:803-531-0021
Mailing Address - Street 1:939 JOHN C. CALHOUN DRIVE
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115
Mailing Address - Country:US
Mailing Address - Phone:803-531-0021
Mailing Address - Fax:
Practice Address - Street 1:939 JOHN C. CALHOUN DRIVE
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115
Practice Address - Country:US
Practice Address - Phone:803-531-0021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2023-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3333122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZA9906Medicaid
SCZA9906Medicaid