Provider Demographics
NPI:1518108901
Name:MILLER, STEPHEN K (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:K
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 1:30 CENTRAL PARK S
Mailing Address - Street 2:SUITE 7C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1628
Mailing Address - Country:US
Mailing Address - Phone:212-755-5557
Mailing Address - Fax:212-775-5205
Practice Address - Street 1:30 CENTRAL PARK S
Practice Address - Street 2:SUITE 7C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1628
Practice Address - Country:US
Practice Address - Phone:212-755-5557
Practice Address - Fax:212-775-5205
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-13
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035382122300000X
NJ012726122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist