Provider Demographics
NPI:1134125313
Name:MILLER, JOHN ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
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:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:ISLE
Mailing Address - State:MN
Mailing Address - Zip Code:56342-0001
Mailing Address - Country:US
Mailing Address - Phone:320-676-3232
Mailing Address - Fax:320-676-8460
Practice Address - Street 1:370 3RD AVE S
Practice Address - Street 2:
Practice Address - City:ISLE
Practice Address - State:MN
Practice Address - Zip Code:56342
Practice Address - Country:US
Practice Address - Phone:320-676-3232
Practice Address - Fax:320-676-8460
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND93321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MND9332OtherPROVIDER LICENSE NUMBER