Provider Demographics
NPI:1356317465
Name:MILLER, JEFFERY L (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:L
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 1:323 NW 24TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-3209
Mailing Address - Country:US
Mailing Address - Phone:210-436-6261
Mailing Address - Fax:210-436-7126
Practice Address - Street 1:323 NW 24TH ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3209
Practice Address - Country:US
Practice Address - Phone:210-436-6261
Practice Address - Fax:210-436-7126
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX840007OtherUNITED CONCORDIA
TX008447701Medicaid
CADELTA DENTALOtherDELTA DENTAL