Provider Demographics
NPI:1073958930
Name:MILLER, BRENDA E (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:E
Last Name:MILLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11750 RANDOLPH CT
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-4187
Mailing Address - Country:US
Mailing Address - Phone:951-313-5068
Mailing Address - Fax:
Practice Address - Street 1:11750 RANDOLPH CT
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-4187
Practice Address - Country:US
Practice Address - Phone:951-313-5068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA623261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice