Provider Demographics
NPI:1275756496
Name:MILLER, ELIZABETH ANN (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-3102
Mailing Address - Country:US
Mailing Address - Phone:812-886-5040
Mailing Address - Fax:812-886-5043
Practice Address - Street 1:622 N 7TH ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-3102
Practice Address - Country:US
Practice Address - Phone:812-886-5040
Practice Address - Fax:812-886-5043
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120105571223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics