Provider Demographics
NPI:1275231847
Name:MILLER, CONNOR MILES (DDS)
Entity Type:Individual
Prefix:DR
First Name:CONNOR
Middle Name:MILES
Last Name:MILLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 S CASTLE ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21231-2601
Mailing Address - Country:US
Mailing Address - Phone:865-235-5866
Mailing Address - Fax:
Practice Address - Street 1:240 S CASTLE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231-2601
Practice Address - Country:US
Practice Address - Phone:865-235-5866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDPENDING122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist