Provider Demographics
NPI:1134132590
Name:MILLER, MICHELLE D (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:D
Last Name:MILLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 OAK AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-1000
Mailing Address - Country:US
Mailing Address - Phone:530-758-8668
Mailing Address - Fax:530-758-1226
Practice Address - Street 1:1621 OAK AVE
Practice Address - Street 2:SUITE A
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-1000
Practice Address - Country:US
Practice Address - Phone:530-758-8668
Practice Address - Fax:530-758-1226
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA373531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice