Provider Demographics
NPI:1437165651
Name:MILLER, CHARLES NOLAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:NOLAN
Last Name:MILLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7631 W 145
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-5511
Mailing Address - Country:US
Mailing Address - Phone:952-432-8696
Mailing Address - Fax:952-432-8972
Practice Address - Street 1:7631 W 145
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-5511
Practice Address - Country:US
Practice Address - Phone:952-432-8696
Practice Address - Fax:952-432-8972
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND107381223G0001X
SDM8261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN09092 KUOtherBLUE CROSS BLUE SHIELD