Provider Demographics
NPI:1558535260
Name:MILLER, JOHN D (DDS, PA)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:MILLER
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 TEQUESTA DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-3087
Mailing Address - Country:US
Mailing Address - Phone:561-746-4004
Mailing Address - Fax:561-746-1212
Practice Address - Street 1:399 TEQUESTA DR
Practice Address - Street 2:SUITE 104
Practice Address - City:TEQUESTA
Practice Address - State:FL
Practice Address - Zip Code:33469-3087
Practice Address - Country:US
Practice Address - Phone:561-746-4004
Practice Address - Fax:561-746-1212
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDN13456122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist