Provider Demographics
NPI:1326188285
Name:MILLER, SUSAN S (DDS, PLLC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:S
Last Name:MILLER
Suffix:
Gender:F
Credentials:DDS, PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7750 15TH AVE NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-4314
Mailing Address - Country:US
Mailing Address - Phone:206-402-3402
Mailing Address - Fax:206-402-3460
Practice Address - Street 1:7750 15TH AVE NE
Practice Address - Street 2:SUITE A
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-4314
Practice Address - Country:US
Practice Address - Phone:206-402-3402
Practice Address - Fax:206-402-3460
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000062181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice