Individual
DR. MATTHEW ALLEN NETTLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
25 WARD ROAD, LUGOFF, SC 29078
(803) 438-1047
(803) 438-4644
Mailing address
25 WARD ROAD, LUGOFF, SC 29078
(803) 438-1047
(803) 438-4644
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DGD.8240 GD
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Z16778
—
SC
05
—
ZX8240
—
SC
Enumeration date
06/25/2013
Last updated
11/08/2018
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