Provider Demographics
NPI:1346532611
Name:JASON R. MILLER, D.M.D., M.D., P.C.
Entity Type:Organization
Organization Name:JASON R. MILLER, D.M.D., M.D., P.C.
Other - Org Name:NORTH ALABAMA ORAL & FACIAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:RUSSEL
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:256-265-4950
Mailing Address - Street 1:910 ADAMS ST SE
Mailing Address - Street 2:STE. 215
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3730
Mailing Address - Country:US
Mailing Address - Phone:256-265-4950
Mailing Address - Fax:256-265-4949
Practice Address - Street 1:910 ADAMS ST SE
Practice Address - Street 2:STE. 215
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3730
Practice Address - Country:US
Practice Address - Phone:256-265-4950
Practice Address - Fax:256-265-4949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.255501223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty