Provider Demographics
NPI:1407933641
Name:DONNA J MILLER DMD DANIEL F GREEN DDS AND JEREMY D CRABTREE DDS INC
Entity Type:Organization
Organization Name:DONNA J MILLER DMD DANIEL F GREEN DDS AND JEREMY D CRABTREE DDS INC
Other - Org Name:FAMILY DENTAL CENTER OF CHILLICOTHE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-773-4066
Mailing Address - Street 1:PO BOX 1007
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601
Mailing Address - Country:US
Mailing Address - Phone:740-773-4066
Mailing Address - Fax:740-773-9174
Practice Address - Street 1:19 EXECUTIVE CENTER DR
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601
Practice Address - Country:US
Practice Address - Phone:740-773-4066
Practice Address - Fax:740-773-9174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0884084Medicaid