Provider Demographics
NPI:1548409485
Name:MILLER, TRACIE R (RDH)
Entity Type:Individual
Prefix:MS
First Name:TRACIE
Middle Name:R
Last Name:MILLER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2574 MARCIA CT
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-2341
Mailing Address - Country:US
Mailing Address - Phone:228-388-9545
Mailing Address - Fax:228-385-1161
Practice Address - Street 1:2574 MARCIA CT
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-2341
Practice Address - Country:US
Practice Address - Phone:228-388-9545
Practice Address - Fax:228-385-1161
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2716-94DH124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist