Provider Demographics
NPI:1437587706
Name:EMILIE D. MILLER, DMD, PC
Entity Type:Organization
Organization Name:EMILIE D. MILLER, DMD, PC
Other - Org Name:SUPER SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-309-7086
Mailing Address - Street 1:54 MIDDLESEX TPKE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-4908
Mailing Address - Country:US
Mailing Address - Phone:781-272-1288
Mailing Address - Fax:
Practice Address - Street 1:54 MIDDLESEX TPKE
Practice Address - Street 2:SUITE 104
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4908
Practice Address - Country:US
Practice Address - Phone:781-272-1288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-24
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110077883AMedicaid