Provider Demographics
NPI:1477571628
Name:MILLER, MICHAEL V (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:V
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 1:325 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-7918
Mailing Address - Country:US
Mailing Address - Phone:918-245-0224
Mailing Address - Fax:918-245-0534
Practice Address - Street 1:325 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-7918
Practice Address - Country:US
Practice Address - Phone:918-245-0224
Practice Address - Fax:918-245-0534
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK51391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice