Provider Demographics
NPI:1013001239
Name:MILLER, DAVID LAWRENCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LAWRENCE
Last Name:MILLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:6701 HERITAGE PKWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-8747
Mailing Address - Country:US
Mailing Address - Phone:972-412-5857
Mailing Address - Fax:972-412-5851
Practice Address - Street 1:6701 HERITAGE PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-8747
Practice Address - Country:US
Practice Address - Phone:972-412-5857
Practice Address - Fax:972-412-5851
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX150661223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU08447Medicare UPIN