Provider Demographics
NPI:1437489135
Name:MILLER DDS OF BRIDGEWATER, PC
Entity Type:Organization
Organization Name:MILLER DDS OF BRIDGEWATER, PC
Other - Org Name:PARKSIDE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-828-3518
Mailing Address - Street 1:100 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:VA
Mailing Address - Zip Code:22812-1755
Mailing Address - Country:US
Mailing Address - Phone:540-828-3518
Mailing Address - Fax:540-828-6667
Practice Address - Street 1:100 PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:VA
Practice Address - Zip Code:22812-1755
Practice Address - Country:US
Practice Address - Phone:540-828-3518
Practice Address - Fax:540-828-6667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-04
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty