Provider Demographics
NPI:1508407750
Name:MILLER DENTAL GROUP
Entity Type:Organization
Organization Name:MILLER DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADRIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GABALDON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:239-455-1018
Mailing Address - Street 1:7219 RADIO RD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34104-6707
Mailing Address - Country:US
Mailing Address - Phone:239-455-1018
Mailing Address - Fax:239-455-2464
Practice Address - Street 1:7219 RADIO RD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34104-6707
Practice Address - Country:US
Practice Address - Phone:239-455-1018
Practice Address - Fax:239-455-2464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental