Provider Demographics
NPI:1346655453
Name:MILLER, TIMOTHY REID (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:REID
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 1:27081 185TH AVE SE STE 105
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-8448
Mailing Address - Country:US
Mailing Address - Phone:253-981-4950
Mailing Address - Fax:
Practice Address - Street 1:27081 185TH AVE SE STE 105
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-8448
Practice Address - Country:US
Practice Address - Phone:253-981-4950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60463337122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist