Provider Demographics
NPI:1326379553
Name:MILLER, KYLE LEON (DMD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:LEON
Last Name:MILLER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 E CENTRAL AVE (MURPHY DENTAL)
Mailing Address - Street 2:
Mailing Address - City:SUTHERLLIN
Mailing Address - State:OR
Mailing Address - Zip Code:97479
Mailing Address - Country:US
Mailing Address - Phone:541-459-1358
Mailing Address - Fax:541-459-7711
Practice Address - Street 1:176 AUBURN CT STE 5
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-3682
Practice Address - Country:US
Practice Address - Phone:805-496-4247
Practice Address - Fax:805-496-9830
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-28
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA583501223G0001X
OR095551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice