Provider Demographics
NPI:1407020969
Name:MILLER, NANCY R (RDA)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:R
Last Name:MILLER
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 BRANSCOMB ROAD
Mailing Address - Street 2:PO BOX 870
Mailing Address - City:LAYTONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95454
Mailing Address - Country:US
Mailing Address - Phone:707-984-8222
Mailing Address - Fax:707-984-7337
Practice Address - Street 1:50 BRANSCOMB ROAD
Practice Address - Street 2:
Practice Address - City:LAYTONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95454
Practice Address - Country:US
Practice Address - Phone:707-984-8222
Practice Address - Fax:707-984-7337
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDH6641124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist