Provider Demographics
NPI:1184840001
Name:MILLER, S MURRAY (DDS CAGS)
Entity Type:Individual
Prefix:
First Name:S
Middle Name:MURRAY
Last Name:MILLER
Suffix:
Gender:M
Credentials:DDS CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 COTTONWOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:NEWTON CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02459-3112
Mailing Address - Country:US
Mailing Address - Phone:617-527-5965
Mailing Address - Fax:617-332-9034
Practice Address - Street 1:1775 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339
Practice Address - Country:US
Practice Address - Phone:781-826-8866
Practice Address - Fax:781-826-1474
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA120821223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0243639OtherMASS HEALTH