Provider Demographics
NPI:1487631297
Name:MILLER, JOEL SIMON (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:SIMON
Last Name:MILLER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2429
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-1719
Mailing Address - Country:US
Mailing Address - Phone:661-257-5858
Mailing Address - Fax:661-257-3660
Practice Address - Street 1:1100 N COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-1944
Practice Address - Country:US
Practice Address - Phone:661-257-5858
Practice Address - Fax:661-257-3660
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32365122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA752442OtherUNITED CONCORDIA