Provider Demographics
NPI:1114641354
Name:MILLER, ARIELLE
Entity Type:Individual
Prefix:
First Name:ARIELLE
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7223 MISSISSIPPI AVE
Mailing Address - Street 2:DENTAC, BLDG 1561
Mailing Address - City:FT POLK
Mailing Address - State:LA
Mailing Address - Zip Code:71459
Mailing Address - Country:US
Mailing Address - Phone:337-531-2603
Mailing Address - Fax:
Practice Address - Street 1:7223 MISSISSIPPI AVE
Practice Address - Street 2:DENTAC, BLDG 1561
Practice Address - City:FT POLK
Practice Address - State:LA
Practice Address - Zip Code:71459
Practice Address - Country:US
Practice Address - Phone:337-531-2603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108186122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist