Provider Demographics
NPI:1376556753
Name:MILLER, MICHAEL J (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:MILLER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2775 VIA DE LA VALLE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-1919
Mailing Address - Country:US
Mailing Address - Phone:858-509-2853
Mailing Address - Fax:858-509-2859
Practice Address - Street 1:2775 VIA DE LA VALLE
Practice Address - Street 2:SUITE 101
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-1919
Practice Address - Country:US
Practice Address - Phone:858-509-2853
Practice Address - Fax:858-509-2859
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44216122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist