Provider Demographics
NPI:1205843455
Name:MILLER, BILL J (DDS MS)
Entity Type:Individual
Prefix:
First Name:BILL
Middle Name:J
Last Name:MILLER
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 S FEDERAL BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80219-5444
Mailing Address - Country:US
Mailing Address - Phone:303-935-0815
Mailing Address - Fax:303-935-0815
Practice Address - Street 1:2200 S FEDERAL BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80219-5444
Practice Address - Country:US
Practice Address - Phone:303-935-0815
Practice Address - Fax:303-935-0815
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35071223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02035079Medicaid