Provider Demographics
NPI:1417003963
Name:MILLER, JASON (DMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:
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 1:1800 GALLERIA BLVD
Mailing Address - Street 2:SPACE 1360
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-1605
Mailing Address - Country:US
Mailing Address - Phone:615-771-8809
Mailing Address - Fax:615-771-8805
Practice Address - Street 1:1800 GALLERIA BLVD
Practice Address - Street 2:SPACE 1360
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-1605
Practice Address - Country:US
Practice Address - Phone:615-771-8809
Practice Address - Fax:615-771-8805
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8072122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN17957Medicaid