Provider Demographics
NPI:1295824084
Name:MILLER, CRAIG E (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:E
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 1:701 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:IOWA FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50126
Mailing Address - Country:US
Mailing Address - Phone:641-648-4293
Mailing Address - Fax:641-648-3784
Practice Address - Street 1:701 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:IOWA FALLS
Practice Address - State:IA
Practice Address - Zip Code:50126
Practice Address - Country:US
Practice Address - Phone:641-648-4293
Practice Address - Fax:641-648-3784
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA05971122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0120840Medicaid