Provider Demographics
NPI:1083634232
Name:MILLER, JEFFREY S (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:S
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 1:17705 HALE AVE STE B1
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-4345
Mailing Address - Country:US
Mailing Address - Phone:408-779-2216
Mailing Address - Fax:
Practice Address - Street 1:17705 HALE AVE STE B1
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-4345
Practice Address - Country:US
Practice Address - Phone:408-779-2216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA378761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice