Provider Demographics
NPI:1003027830
Name:MILLER, CLYDE EDWARD (DDS)
Entity Type:Individual
Prefix:
First Name:CLYDE
Middle Name:EDWARD
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 1:9598 E SOUTHWIND LN
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85262-3656
Mailing Address - Country:US
Mailing Address - Phone:480-473-0226
Mailing Address - Fax:
Practice Address - Street 1:9377 E BELL RD STE 301
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1505
Practice Address - Country:US
Practice Address - Phone:480-513-2620
Practice Address - Fax:480-513-9308
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD54151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice