Provider Demographics
NPI:1346536596
Name:MILLER, NATHAN WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:WILLIAM
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 1:4062 ST TROPEZ CT
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-9539
Mailing Address - Country:US
Mailing Address - Phone:480-452-3022
Mailing Address - Fax:
Practice Address - Street 1:560 W 26TH ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-2837
Practice Address - Country:US
Practice Address - Phone:209-723-5405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD008237122300000X
CA61768122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist