Provider Demographics
NPI:1083834576
Name:MILLER, LANCE T (DDS)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:T
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 1:749 UNIVERSITY ROW
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705
Mailing Address - Country:US
Mailing Address - Phone:608-238-7112
Mailing Address - Fax:608-238-1061
Practice Address - Street 1:749 UNIVERSITY ROW
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705
Practice Address - Country:US
Practice Address - Phone:608-238-7112
Practice Address - Fax:608-238-1061
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5131122300000X, 1223G0001X
261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice