Provider Demographics
NPI:1356639207
Name:MILLER, SHAWNELL M (RDH)
Entity Type:Individual
Prefix:
First Name:SHAWNELL
Middle Name:M
Last Name:MILLER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:SHAWNELL
Other - Middle Name:M
Other - Last Name:O'MALLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:123 S 27TH ST
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-4200
Mailing Address - Country:US
Mailing Address - Phone:406-651-6436
Mailing Address - Fax:
Practice Address - Street 1:123 S 27TH ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-4200
Practice Address - Country:US
Practice Address - Phone:406-651-6436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT970124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist