Individual
DR. TRAVIS WAYNE MIZE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D., M.H.S.
Contact information
Practice address
159 MEDICAL CIR, WEST COLUMBIA, SC 29169-3655
(803) 794-7520
Mailing address
159 MEDICAL CIR, WEST COLUMBIA, SC 29169-3655
(803) 794-7520
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
4466
SC
1223P0300X
Periodontics
Primary
826
SC
1223P0300X
Periodontics
DN1855503
MA
Other
Enumeration date
09/22/2008
Last updated
06/04/2015
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