Provider Demographics
NPI:1285855494
Name:MILLER, THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
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 1:10302 SOUTHSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-0706
Mailing Address - Country:US
Mailing Address - Phone:904-363-3366
Mailing Address - Fax:904-363-9611
Practice Address - Street 1:10302 SOUTHSIDE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-0706
Practice Address - Country:US
Practice Address - Phone:904-363-3366
Practice Address - Fax:904-363-9611
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN8934122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist