Provider Demographics
NPI:1164176806
Name:NICOLE R MILLER DDS
Entity Type:Organization
Organization Name:NICOLE R MILLER DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COOTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-613-1517
Mailing Address - Street 1:3809 FORRESTGATE DR STE A
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-2982
Mailing Address - Country:US
Mailing Address - Phone:336-768-9010
Mailing Address - Fax:336-768-9011
Practice Address - Street 1:3309 HEALY DR STE D
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1474
Practice Address - Country:US
Practice Address - Phone:336-765-1066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental