Matthew Allen Nettles, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DGD.8240 GD Issued in SC

Practice address

25 Ward Road
Lugoff, SC 29078

Phone

(803) 438-1047

Fax

(803) 438-4644

NPI assigned

Jun 25, 2013

Last updated

Nov 8, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1372118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541635200000",
    "number": "1336589233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 WARD ROAD",
            "city": "LUGOFF",
            "state": "SC",
            "postal_code": "29078",
            "telephone_number": "803-438-1047",
            "fax_number": "803-438-4644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 WARD ROAD",
            "city": "LUGOFF",
            "state": "SC",
            "postal_code": "29078",
            "telephone_number": "803-438-1047",
            "fax_number": "803-438-4644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NETTLES",
        "first_name": "MATTHEW",
        "middle_name": "ALLEN",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-25",
        "last_updated": "2018-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "DGD.8240 GD",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZX8240",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Z16778",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Allyson Varn Monferdini, D.M.D.
• Courtney Rampey Morris, RN
• Julie Ann Mullins, D.O.
• Stephanie Alexandria Nelson
• Denielle Marie Nesbitt, MS, LPC
• Alyssa L Norwood, PHARMD
• Joel Richard Oliver, MD
• Jacob Patrick Ossoff, M.D.
• Megan Smith Oxford, APRN FNP-BC
• Karen Parham, MA

• General Practice Dentistry in Lugoff, SC
• Providers in Lugoff, SC by specialty
• General Practice Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.