Provider Demographics
NPI:1487658001
Name:MILLER, JULIAN PATRICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:JULIAN
Middle Name:PATRICK
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 1:4528 1/4 EDGEWOOD PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-1801
Mailing Address - Country:US
Mailing Address - Phone:734-330-5913
Mailing Address - Fax:
Practice Address - Street 1:550 E DEL AMO BLVD
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3314
Practice Address - Country:US
Practice Address - Phone:310-515-5672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA578191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice