Provider Demographics
NPI:1336497445
Name:MILLER, SHAWN CAROL (DDS)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:CAROL
Last Name:MILLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 MERHAR AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-3166
Mailing Address - Country:US
Mailing Address - Phone:907-328-0868
Mailing Address - Fax:
Practice Address - Street 1:410 MERHAR AVE STE 5
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-3166
Practice Address - Country:US
Practice Address - Phone:907-328-0868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28115122300000X
AK1434122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist