Provider Demographics
NPI:1508275173
Name:MILLER, KYLE CAMERON (DMD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:CAMERON
Last Name:MILLER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5307 E YALE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-6901
Mailing Address - Country:US
Mailing Address - Phone:303-825-3818
Mailing Address - Fax:303-825-3819
Practice Address - Street 1:5307 E YALE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-6901
Practice Address - Country:US
Practice Address - Phone:303-825-3818
Practice Address - Fax:303-825-3819
Is Sole Proprietor?:No
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00202249122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist