Provider Demographics
NPI:1366449761
Name:MILLER, CHARLES W (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:W
Last Name:MILLER
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4220 LITTLE ROAD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016
Mailing Address - Country:US
Mailing Address - Phone:817-478-2300
Mailing Address - Fax:817-478-4904
Practice Address - Street 1:4220 LITTLE ROAD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016
Practice Address - Country:US
Practice Address - Phone:817-478-2300
Practice Address - Fax:817-478-4904
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX125971223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133274407Medicaid
TX133274409Medicaid