Provider Demographics
NPI:1225780208
Name:MILLER, KALASHINI AMELIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:KALASHINI
Middle Name:AMELIA
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 1:73929 LARREA ST STE 2
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-4305
Mailing Address - Country:US
Mailing Address - Phone:310-488-3442
Mailing Address - Fax:760-846-7953
Practice Address - Street 1:73929 LARREA ST.
Practice Address - Street 2:SUITE 2
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260
Practice Address - Country:US
Practice Address - Phone:760-340-1030
Practice Address - Fax:760-346-7953
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA378771223S0112X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty