Provider Demographics
NPI:1548401433
Name:MILLER, LARRY C (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:C
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 1:711 E 70TH ST # A
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4810
Mailing Address - Country:US
Mailing Address - Phone:912-352-4386
Mailing Address - Fax:912-354-3584
Practice Address - Street 1:711 E 70TH ST # A
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4810
Practice Address - Country:US
Practice Address - Phone:912-352-4386
Practice Address - Fax:912-354-3584
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7358122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist