Provider Demographics
NPI:1417115650
Name:MILLER, ANNA MARIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:968 WEST 3RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-6607
Mailing Address - Country:US
Mailing Address - Phone:563-556-3468
Mailing Address - Fax:563-556-1373
Practice Address - Street 1:968 WEST 3RD
Practice Address - Street 2:SUITE 250
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-6607
Practice Address - Country:US
Practice Address - Phone:563-556-3468
Practice Address - Fax:563-556-1373
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08466122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist