Provider Demographics
NPI:1487202370
Name:MILLER HILL DENTAL PLLC
Entity Type:Organization
Organization Name:MILLER HILL DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:DONOVAN
Authorized Official - Last Name:HAMMER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:218-728-5095
Mailing Address - Street 1:1432 LONDON RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2425
Mailing Address - Country:US
Mailing Address - Phone:218-728-5095
Mailing Address - Fax:
Practice Address - Street 1:1432 LONDON RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2425
Practice Address - Country:US
Practice Address - Phone:218-728-5095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KYLE HAMMER DDS PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty