Provider Demographics
NPI:1235139544
Name:MILLER, MARK WAYNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:WAYNE
Last Name:MILLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5201 DEER VALLEY RD
Mailing Address - Street 2:STE 3B
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-7429
Mailing Address - Country:US
Mailing Address - Phone:925-754-6020
Mailing Address - Fax:925-754-5082
Practice Address - Street 1:5201 DEER VALLEY RD
Practice Address - Street 2:STE 3B
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-7429
Practice Address - Country:US
Practice Address - Phone:925-754-6020
Practice Address - Fax:925-754-5082
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA259511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice