Provider Demographics
NPI:1073676045
Name:MILLER, EDWARD J (DDS)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:J
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:PO BOX 1178
Mailing Address - Street 2:
Mailing Address - City:ANACONDA
Mailing Address - State:MT
Mailing Address - Zip Code:59711-1178
Mailing Address - Country:US
Mailing Address - Phone:406-563-6660
Mailing Address - Fax:406-563-2387
Practice Address - Street 1:115 W COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:ANACONDA
Practice Address - State:MT
Practice Address - Zip Code:59711-2246
Practice Address - Country:US
Practice Address - Phone:406-563-6660
Practice Address - Fax:406-563-2387
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT15991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT110500Medicaid
MT15994OtherBLUE CROSS BLUE SHIELD