Provider Demographics
NPI:1013945484
Name:MILLER, MARSHALL VERNON (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:VERNON
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 1:118 S GOOSE CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-3136
Mailing Address - Country:US
Mailing Address - Phone:843-764-3081
Mailing Address - Fax:843-764-4977
Practice Address - Street 1:118 S GOOSE CREEK BLVD
Practice Address - Street 2:BOX 38
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-3136
Practice Address - Country:US
Practice Address - Phone:843-764-3081
Practice Address - Fax:843-764-4977
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice