Provider Demographics
NPI:1265670608
Name:DAVID L MILLER DDS PC
Entity Type:Organization
Organization Name:DAVID L MILLER DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-694-2270
Mailing Address - Street 1:6011 PORTER RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8538
Mailing Address - Country:US
Mailing Address - Phone:810-694-2270
Mailing Address - Fax:810-694-2129
Practice Address - Street 1:6011 PORTER RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8538
Practice Address - Country:US
Practice Address - Phone:810-694-2270
Practice Address - Fax:810-694-2129
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVID L MILLER DDS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI100061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4056318Medicaid