Provider Demographics
NPI:1114366226
Name:MILLER, JENNIFER J (RDH)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:J
Last Name:MILLER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:J
Other - Last Name:HASKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:7407 ALVARADO RD # 89
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-8904
Mailing Address - Country:US
Mailing Address - Phone:757-897-6860
Mailing Address - Fax:
Practice Address - Street 1:BLDG 600 MCCAIN BLVD
Practice Address - Street 2:BRANCH DENTAL CLINIC NORTH ISLAND
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92135
Practice Address - Country:US
Practice Address - Phone:619-545-6397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10908106124Q00000X
VA0402203674124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist