Provider Demographics
NPI:1851918585
Name:MCKEEMAN, MATTHEW CLAYTON (DMD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:CLAYTON
Last Name:MCKEEMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 SEAPORT LN UNIT 2218
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3778
Mailing Address - Country:US
Mailing Address - Phone:610-675-5336
Mailing Address - Fax:
Practice Address - Street 1:1204 TWO ISLAND CT
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-7436
Practice Address - Country:US
Practice Address - Phone:843-881-8881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-29
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC99851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice