Provider Demographics
NPI:1154842466
Name:MILLER AND SKINNER DENTAL CORPORATION
Entity Type:Organization
Organization Name:MILLER AND SKINNER DENTAL CORPORATION
Other - Org Name:MERCED FAMILY DENTISTRY LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-723-5405
Mailing Address - Street 1:560 W. 26TH ST.
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340
Mailing Address - Country:US
Mailing Address - Phone:209-723-5405
Mailing Address - Fax:209-723-2321
Practice Address - Street 1:560 W. 26TH ST.
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340
Practice Address - Country:US
Practice Address - Phone:209-723-5405
Practice Address - Fax:209-723-2321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-28
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA617681223G0001X
CA1002361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty